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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604080
Report Date: 11/04/2024
Date Signed: 11/04/2024 02:11:31 PM

Document Has Been Signed on 11/04/2024 02:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SAPPHIRE SUNSETFACILITY NUMBER:
374604080
ADMINISTRATOR/
DIRECTOR:		DRAPEAU, YORDAYLDAPFACILITY TYPE:
740
ADDRESS:1380 REES RDTELEPHONE:
(714) 322-1910
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY: 6CENSUS: 6DATE:
11/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Administrator, Daphne DrapeauTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA), Janette Romero arrived unannounced to the facility to conduct a case management visit to address a deficiency observed during the investigation of complaint control number 18-AS-20220826154813. LPA met with Administrator, Daphne Drapeau.

On August 24, 2022 at approximately 8:00 AM, Resident #1 (R1) was discovered missing from the facility. An interview conducted with Staff #1 (S1) revealed they immediately contacted Licensee, Ali Naghibi to inform them of the missing resident rather than call local law enforcement. Furthermore, phone records reviewed revealed R1’s responsible party was not notified R1 was missing until 9:32 AM. A further review of phone records revealed local law enforcement still had not been contacted by 10:39 AM. An interview with San Diego County Sheriff's Department staff revealed a call was finally received from the facility at 11:12 AM to report R1 missing. Therefore, the facility failed to contact R1’s responsible party and local law enforcement to report R1 was missing in a timely manner.

The following deficiency was cited per Title 22, Division 6 of the California Code of Regulations on the attached LIC809-D. An exit interview was conducted, and a copy of this report was provided along with Appeal Rights as well as Confidential Names list (LIC 809).
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/04/2024 02:11 PM - It Cannot Be Edited


Created By: Janette Romero On 11/04/2024 at 01:45 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SAPPHIRE SUNSET
FACILITY NUMBER: 374604080

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/11/2024
Section Cited
CCR
87465(g)

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The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidenced by:
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Administrator Drapeau stated the facility will conduct a staff refresher training regarding 'Incidental Medical and Dental Care'. Proof of correction will be submitted to LPA by close by of business on 11/11/2024.
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The licensee did not ensure 911 was contacted immediately after staff discovered R1 was missing at 8:00 AM. Based on interviews conducted and records reviewed, local law enforcement was not contacted until 11:12 AM. This poses a potential health, safety, and personal rights risk to residents 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.
SUPERVISOR'S NAME:Tricia Danielson
LICENSING EVALUATOR NAME:Janette Romero
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2024


LIC809 (FAS) - (06/04)
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