White Orchid Guest Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Robert Campbell conducted an unannounced annual required visit. Upon entry, LPA were greeted by Jocelyn Estepa, Caregiver, and informed them of the purpose of the visit. At the time of the visit, there was one (1) staff member and three (3) residents present. Stan Estepa/Administrator, came out of a room later during the visit. Facility Overview: The facility is a one-story home with five (5) bedrooms and three (3) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility has infection control plan in file. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 110°F. Fire extinguisher located at kitchen. LPA observed outside a lot of debris that needs to be thrown away detailed in the LIC809D form. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C.... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for three (3) staff members, confirming criminal clearances, and CPR/First Aid certification. Three (3) resident files were reviewed and contained most required documents. LPA detailed the staff Type B deficiency on the LIC809D. Health-Related Services/Incidental Medical Services: All resident medications were securely locked in kitchen cabinet. LPA reviewed medications for three (3) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Personal & Incidental Funds: All monies are not handled by the facility. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including no documentation of the last emergency drill. LPA issued a technical violation for not have quarterly emergency drills. LPA will have all residents and staff participate in an emergency drill by 7/19/2026 submitted to LPA by email. All facility exits were clear of obstructions. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Jun 19, 2026

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

*This is a superseded report to LIC 9099 dated April 22, 2026* On April 23, 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 22, 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 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. Page 2 of 3 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. Page 3 of 3the state’s words, verbatim · CDSS document, Apr 23, 2026 · control 18-AS-20230628143136

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Apr 24, 2026

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. 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.the state’s words, verbatim · CDSS document, Apr 23, 2026

Plan of correction: 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.

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

*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 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. Page 2 of 3 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. Page 3 of 3the state’s words, verbatim · CDSS document, Apr 22, 2026 · control 18-AS-20230628143136

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87456 · Plan of correction due date: Apr 23, 2026

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. 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.the state’s words, verbatim · CDSS document, Apr 22, 2026

Plan of correction: 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.

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

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 purpose for visit explained. Investigation consisted of the following: On July 6, 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 the Department interviewed witness 1 (W1) via telephone. On April 8, 2026 the department received via documentation (written dispensation) from police report # 230044925 taken on 6/21/23. On April 9, 2026 The department obtained a copy of 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). The department interviewed Administrator (A1) and 1 staff (S1), interview attempt (R1). Page 1 of 3 Substantiated 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 it 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. Page 2 of 3 On 4/8/26 the Department obtained and reviewed police report # 230044925 which stated: “Subject was mistakenly given copious amounts of medication by the caregiving 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. Page 3 of 3the state’s words, verbatim · CDSS document, Apr 9, 2026 · control 18-AS-20230628143136

From the deficiency page — Deficiency type: Type B · Section cited: CCR 67465(a)4) · Plan of correction due date: Apr 23, 2026

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. 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 a potential safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 9, 2026

Plan of correction: Licensee will ensure compliance by reviewing regulation Title 22 67465 (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.

Type of visit: Case Management - Deficiencies

On April 9, 2026 Licensing Program Analyst(LPA) Deborah Lee conducted an unannounced Case Management- Deficiencies. During the course of investigation complaint 18-AS-20230628143136, the facility was unable to provide incident report for incident involving R1 not Metoprolol Succinate on 6/21/23 as prescribed. See attached 809D Title 22 Division 6 being cited An exit interview was conducted with Jo Estepa and A copy of this report and appeals rights were provided.the state’s words, verbatim · CDSS document, Apr 9, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Apr 23, 2026

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of...(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as the faciltiy was unable to provide incident report for incident on 6/21/23 where 911 and law enforcement were call.the state’s words, verbatim · CDSS document, Apr 9, 2026

Plan of correction: Licensee will ensure compliance by reviewing regulation Title 22 87211(a)(1)(D) for understanding and develop a plan for future compliance. Submit plan to LPA Lee Deborah.Lee@dss.ca.gov by due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Administrator, Stan Estepa who was informed of the purpose of the visit. At the time of the visit there was (2) staff and (5) residents present. The facility is a one story home with (5) bedrooms and (2) bathrooms with attached garage. No pools or firearms are being kept at the facility. The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. The sharp and dangerous objects were observed to be locked and inaccessible to residents. The carbon monoxide was operational, and the hot water temperature 117.8F. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required food supply. LPA reviewed (2) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Two (2) client files were reviewed, and possessed all required paperwork. All client medication was locked in closet. LPA reviewed documentation showing the facility's last fire drill 3/3/2024, which met the department requirements. LPA observed all facility exits were clear from obstructions. An exit interview was conducted where this report was reviewed and provided.the state’s words, verbatim · CDSS document, Jun 27, 2024