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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603777
Report Date: 08/25/2023
Date Signed: 08/25/2023 11:39:41 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
07/24/2023 and conducted by Evaluator Kathleen Banrasavong
COMPLAINT CONTROL NUMBER: 18-AS-20230724103142
FACILITY NAME:MARIPOSA MANORFACILITY NUMBER:
374603777
ADMINISTRATOR:WELKER, KELLYFACILITY TYPE:
740
ADDRESS:2525 REED ROADTELEPHONE:
(760) 294-7011
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:6CENSUS: 6DATE:
08/25/2023
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Caregiver, Dalia CalderonTIME COMPLETED:
11:55 AM
ALLEGATION(S):
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Staff do not allow resident to have visitors.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kathleen Banrasavong made an unannounced visit to the facility to commence a complaint investigation regarding the allegation(s) listed above. LPA met with Administrator, Garrett Welker, where LPA explained the purpose of the visit and the elements of the allegation(s). The allegation(s) were investigated, the investigation consisted of observation, interviews with three staff members and five residents, and record review.
On 07/24/2023 , Community Care Licensing received a complaint stating that Staff do not allow residents to have visitors. This complaint was made by the Reporting party which states they were not allowed to visit R3. Information from Administration and staff interviews reveal that the facility has an open visitation policy, except for Resident #3 (R3). Due to R3’s special health condition and conservatorship, he is not allowed to have certain visitors that can cause harm to his health condition.
(Contiuned on 9099-C)
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
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 18-AS-20230724103142
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MARIPOSA MANOR
FACILITY NUMBER: 374603777
VISIT DATE: 08/25/2023
NARRATIVE
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(Continuation from 9099)
The LPA reviewed documentation regarding the facility’s program statement-regarding visitation, visitors log, general placement agreement. LPA reviewed Letters of Temporary Guardianship or Conservatorship based on Probate Code Section 2351 which the refusal of visitors was granted. It was reported that R3’s conservator created a list of approved visitors and people who were not allowed to visit R3. The facility was implementing this restriction on visitors based on the conservator’s wishes and court approval.
The LPA provided regulatory information to the facility regarding every resident’s right to have or refuse visitation from family, friends, or otherwise, as well as information concerning the inability of any conservator or Power of Attorney to restrict a visit to a resident based on CCR 87468.2 (a)(21). (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (21) To consent to have their relatives and other individuals of their choosing visit during reasonable hours, privately, and without prior notice. However, due to the court’s ruling on R3’s conservatorship and Probate code Section 2351, the court’s ruling shall override the regulation CCR 87468.2 (a)(21) and PIN 21-48 ASC.
Based on LPA’s observation, interview conducted and record review(s), the preponderance of evidence show the allegation of Staff not allowing residents to have visitor is unfounded. This agency has investigated the complaint and we have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
An exit interview was conducted, a copy of this report, was provided to the Administrator, Garrett Welker and Caregiver, Dalia Calderon, whom signed for the report as evidenced by her signature.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2