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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603092
Report Date: 04/22/2026
Date Signed: 04/22/2026 01:20:52 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2023 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 18-AS-20230628143136
FACILITY NAME:WHITE ORCHID GUEST HOMEFACILITY NUMBER:
374603092
ADMINISTRATOR:ESTEPA, STANFACILITY TYPE:
740
ADDRESS:978 WEST 2ND AVETELEPHONE:
(760) 737-6030
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:5CENSUS: 4DATE:
04/22/2026
UNANNOUNCEDTIME BEGAN:
09:47 AM
MET WITH:Jo EstepaTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not distribute resident's medication as prescribed
INVESTIGATION FINDINGS:
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*This is a superseded report to LIC 9099 dated April 9, 2026*
On April 22, 2026, the Department conducted a subsequent visit to deliver this superseded report. The purpose of this report is to correct the 9099D deficiency page. Although this report supersedes the report dated April 9, 2026, it does not change the findings.
On April 9, 2026, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegation and to deliver findings. The Department was met by Jo Estepa and reason for visit explained
Investigation consisted of the following:
On June 21, 2023 the Department conducted an unannounced initial visit to the facility to investigate the complaint allegation mentioned above. During the visit, it was determined that the complaint required further investigation.
On April 7,2026 via telephone the Department interviewed witness 1 (W1).
On April 8, 2026 the department received documentation (written dispensation) from police report taken on 6/21/23.
On April 9, 2026 The department obtained a copy of resident roster, incident report (dated: ) interviewed Administrator (A1) and 1 staff (S1)

Page 1 of 3
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
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 4
Control Number 18-AS-20230628143136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WHITE ORCHID GUEST HOME
FACILITY NUMBER: 374603092
VISIT DATE: 04/22/2026
NARRATIVE
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The investigation revealed the following:

Allegation: Staff did not distribute resident's medication as prescribed

The detail of complaint alleges on 6/21/23 staff gave R1 more medication than prescribed by R1’s physician.

On April 9, 2026 at 10:52 am, the Department interviewed Administrator A1 via telephone regarding the allegation who did not deny allegation. When asked if R1 was given more medication than what was prescribed, A1 responded “Yes, but we were following the RN’s instructions, and she said it was okay to give medication like that.”

On April 9, 2026 at 11:00am, The department interviewed S1, regarding allegations S1 admitted that she has made a mistake. S1 went on to explain the following to the Department: R1’s medication is (Metoprolol 25 mg) to be given 3 tablets in morning and 2 tablet in the evening (totaling 5 tablet in a day) but "I made the mistake of giving him all 5 tablets at once because he demanded it. so I gave it to him." S1 stated that she called his RN from the VA, and notified R1's family, and called 911. S1 further stated, “I know it was my fault that I made a mistake…I have learned from it, I go by doctor instructions only.”

On 4/7/26, the Department spoke with Officer Austin (W1) of the Escondido PD who stated that he does remember going out on a call to facility with the Mental Health Clinician because it was reported that R1 was given “way too many meds that what was allowed” by the doctor. W1 further stated that R1 was refusing any medical attention and had a vague threat of suicide that is why the PD became involved.

On 4/9/26 the Department attempted to interview R1 via telephone, there was no answer.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20230628143136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WHITE ORCHID GUEST HOME
FACILITY NUMBER: 374603092
VISIT DATE: 04/22/2026
NARRATIVE
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On 4/8/26 the Department obtained and reviewed police report # 230044925 which stated: “Subject was mistakenly given copious amounts of medication by the care giving staff. When he [R1] was told about the side effects of the medications, he [R1] made a vague Suicidal Ideation (SI) statement about, "not caring." Subject had his daughter in law present and has no access to means to harm himself. Denied SI just having a difficult time with the upcoming anniversary of his wife's passing. Subject connected to mental health services and has 24 hour care. Subject was alert and oriented and refused transport. Advised staff to monitor for medical issues and call 911 should he need assistance.”

On April 9, 2026 The department obtained a copy R1 Physicians report (dated 6/17/25), R1's physician's order/Pharmacy list (dated 6/30/23), R1's Appraisal Needs and Services Plan (dated:4/9/25).

R1’s physician order: Metoprolol Succinate 25mg tabs: take three tablets by mouth morning and take two tablets every evening for arrhythmia (heart rhythm)

Based on the information gathered and reviewed, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title twenty-two (22), Division six (6), is being cited, please see attached LIC-9099D.

An exit interview was conducted with Jo Estepa and A copy of this report and appeals rights were provided.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20230628143136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WHITE ORCHID GUEST HOME
FACILITY NUMBER: 374603092
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
04/23/2026
Section Cited
CCR
87456
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical anddental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assistresidents with self-administered medications as needed.
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Licensee will ensure compliance by reviewing regulation Title 22 87465 (a)(4) for understanding and will retrain all staff on Medication Administration. Submit Training sign-in sheet by due date to LPA Deborah.Lee@dss.ca.gov.
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This requirement is not met as evidenced by:
Based on records review and interviews
conducted, the licensee did not comply with the section cited above as S1 didn't give R1 Metoprolol Succinate on 6/21/23 as prescribed. Which posed an immediate safety, or personal rights risk to persons in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4