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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602567
Report Date: 12/19/2024
Date Signed: 12/19/2024 12:23:45 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2021 and conducted by Evaluator Alyssa Ramirez
COMPLAINT CONTROL NUMBER: 08-AS-20210819121422
FACILITY NAME:WOODLAND GARDEN RESIDENTIAL CARE IIFACILITY NUMBER:
374602567
ADMINISTRATOR:BENITO ENCABOFACILITY TYPE:
740
ADDRESS:1709 KATY PLACETELEPHONE:
(760) 294-5728
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:6CENSUS: 5DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Benito EncabTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility did not follow protocol after scabies outbreak.
Facility exceeded current hospice waiver.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Administrator Benito Encabo and discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of records review, interviews with facility staff, clients and outside agency.

On 8/19/2021, it was reported to CCL that facility did not follow protocol after Scabies outbreak and facility exceeded current hospice waiver.

Regarding the allegation, facility did not follow protocol after Scabies Outbreak, it was reported that facility had a Scabies outbreak and clothing and bedding were not being washed.

[Continued on 9099-C]
.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 08-AS-20210819121422
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: WOODLAND GARDEN RESIDENTIAL CARE II
FACILITY NUMBER: 374602567
VISIT DATE: 12/19/2024
NARRATIVE
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Interviews with facility staff revealed that current staff have knowledge of what to do in the even of a Scabies outbreak and facility staff reported that there was Scabies in the facility in 2021 and protocol was followed that included the washing of clothing and bedding. Review of records revealed that facility has a Scabies Protocol and guidance document that instructs staff to wash clothing and bedding with hot water.

Regarding the allegation, facility exceeded hospice waiver, it was reported that the facility had a hospice waiver for two residents but had more than two residents on hospice. Interviews with facility staff reported that facility took appropriate measures and requested an increase in hospice waivers in 2021. Records review revealed that facility submitted requests for hospice waivers to the San Diego Regional office in 2021.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid. No deficiencies were cited today.



An exit interview was conducted with Administrator. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Administrator whose signature below verifies receipt of these rights.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2