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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197803389
Report Date: 08/25/2023
Date Signed: 08/25/2023 03:09:23 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/07/2022 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20220307102218
FACILITY NAME:ORANGE COMMUNITY CAREFACILITY NUMBER:
197803389
ADMINISTRATOR:SAAFIR, AHMEDFACILITY TYPE:
735
ADDRESS:2103 ORANGE AVENUETELEPHONE:
(562) 599-0856
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:36CENSUS: 34DATE:
08/25/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:MANAGER NATE STOCKARDTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Administrator absent from the facility
Staff do not provide a safe and healthful environment
Residents clothing are not cleaned
Facility is in disrepair
Facility has black mold
Facility has rats/cockroaches
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the Orange Community Care facility on 03/16/2022 and was greeted by Administrator Ahmed Saafir (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

During this investigation, LPA Calderon interviewed A1, S1-S2, R1, R2-R6. This interview was conducted on 3/15/2022, 3/16/2022. On 3/16/2022 LPA Calderon requested copies of the following: staff and residents’ roster, SIR reports (for current complaint), physician’s report (12/24/2020), appraisal/needs and service plan (12/24/2020), psychiatric admission summary (10/09/2019).

The investigation revealed the following:
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
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 12
Control Number 11-AS-20220307102218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ORANGE COMMUNITY CARE
FACILITY NUMBER: 197803389
VISIT DATE: 08/25/2023
NARRATIVE
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Regarding Allegation #1: Administrator absent from the facility.

This complaint alleges that the administrator is absent from the facility. On 03/16/2022 LPA Calderon interviewed A1 for complaint. A1 expressed that A1 is at the facility every day and if A1 is not at the facility staff can reach A1 by cell phone. On 03/16/2022 LPA Calderon interviewed S1 for complaint. S1 expressed that A1 does not come to the facility daily and can be reached by cell phone. S1 expressed that S1 takes care of the facility daily. On 3/15/2022 LPA Calderon interviewed R1 for complaint. R1 expressed that A1 is only at the facility every 3 months and that S1 house manager runs the facility daily. On 03/16/2022 LPA Calderon interviewed R2-R6 for complaint. R2-R6 expressed that A1 comes to the facility one time a month and that S1 House Manager is the person running the facility daily. On 03/16/2022 LPA Calderon toured the facility with S1 office manager who then called A1 by cell phone. A1 arrived at the facility around 10 am to speak to LPA Calderon.

Regarding Allegation #2: Staff do not provide a safe and healthful environment.

This complaint alleges that staff do not provide a safe and healthful facility. On 3/16/2022 LPA Calderon interviewed A1 for complaint. A1 expressed that resident’s mattress has never been changed and there are bed bugs in the facility and other pest. A1 expressed that A1 would not take a shower in any resident bathroom due to shower conditions. On 03/16/2022 LPA Calderon interviewed S2 for complaint. S2 expressed that S2 is only one person who cleans the facility, cleans clothes, cleans bathrooms and the facility needs to hire more staff to clean the facility. S2 expressed that S2 does the best S2 can but residents dirty the bathrooms and facility. On 03/15/2022 LPA Calderon interviewed R1 for complaint. R1 expressed that the facility does not clean and there is trash everywhere, bedbugs in every room and bathrooms are dirty. On 03/16/2022 LPA Calderon interviewed R2-R6 who expressed that staff do not clean the facility and there is trash all over the facility. On 03/15/2022 LPA toured the facility with A1, S1 and noted that the facility had trash all over the facility, LPA Calderon noted bedbugs, black mold in many bathrooms and facility was not cleaned or maintained by staff.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 12
Control Number 11-AS-20220307102218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ORANGE COMMUNITY CARE
FACILITY NUMBER: 197803389
VISIT DATE: 08/25/2023
NARRATIVE
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Regarding Allegation #3: Resident clothing are not cleaned.

This complaint alleges that staff do not clean residents’ clothes. On 03/16/2022 LPA Calderon interviewed A1 for complaint. A1 expressed that there is one staff member that cleans residents’ clothes. A1 expressed that residents put their dirty clothes in a plastic bag and leave their bags in front of the laundry room. A1 expressed that staff takes residents dirty clothes and washes the residents’ clothes and then returns the clean clothes to the residents. On 03/16/2022 LPA Calderon interviewed S2 for complaint. S2 expressed that S2 is the only staff member who cleans residents’ clothes, and the facility needs to hire more staff to help clean the residents’ clothes. On 03/15/2022 LPA Calderon interviewed R1 for complaint. R1 expressed that staff do not clean residents’ clothes and that dirty clothes pile up in front of the laundry room due to not enough staff to help clean residents’ clothes. On 03/16/2022 LPA Calderon interviewed R2-R6 for complaint. R2-R6 expressed that the facility does not clean their clothes. R2-R6 express that residents drop off their dirty clothes and staff do not clean their clothes. On 03/16/2022 LPA Calderon toured the facility with A1, S1 and LPA Calderon notice dirty clothes on the ground or in plastic bags which appeared to be piled up.

Regarding Allegation #4: Facility is in disrepair.

This complaint alleges that the facility is in disrepair. On 03/16/2022 LPA Calderon interviewed A1 for complaint. A1 expressed that staff work every day on facility repair. A1 expressed that staff does repair facility damage as soon as the damage is reported or noticed by staff. On 03/16/2022 LPA Calderon interviewed S1-S2 for complaint. S1-S2 expressed that A1 needs to hire more staff to keep up with cleaning and maintenance of the facility. On 03/15/2022 LPA Calderon interviewed R1 for complaint. R1 expressed that there is black mold in the bathroom, holes in the walls and trash everywhere. On 03/16/2022 LPA Calderon interviewed R2-R6 for complaint. R2-R6 expressed that there is mold everywhere and holes in the walls. R2-R6 expressed that staff do not repair damage to the facility, do not repair damage to walls, damage to bathrooms. On 03/16/2022 LPA Calderon toured the facility with A1, S1 for complaint. LPA Calderon noted major issues with trash all over the facility, broken mirrors in bathrooms, running water from bathroom sinks. LPA Calderon noted holes in walls and bathroom lights not working.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 12
Control Number 11-AS-20220307102218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ORANGE COMMUNITY CARE
FACILITY NUMBER: 197803389
VISIT DATE: 08/25/2023
NARRATIVE
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Regarding Allegation #5: Facility has black mold.

This complaint alleges that the facility has black mold. On 03/16/2022 LPA Calderon interviewed A1 for complaint. A1 expressed that there is black mold in the bathrooms and that staff is working on cleaning up the black mold wherever staff or residents report finding mold. On 03/16/2022 LPA Calderon interviewed S1-S2 for complaint. S1-S2 expressed that there is only one staff member that cleans the facility daily and there is not enough staff to clean the entire facility. S1-S2 expressed that black mold has been reported by residents in the bathrooms. On 03/15/2022 LPA Calderon interviewed R1 for complaint. R1 expresses that there is black mold in the bathrooms and on walls. On 03/16/2022 LPA Calderon interviewed R2-R6 for complaint. R2-R6 all expressed to have seen mold inside the bathrooms. R2-R6 expressed that R2-R6 have reported the mold to A1 and A1 has not done anything to get rid of the mold. On 03/16/2022 LPA toured the facility with A1, S1 and noted by physical inspection that there was black mold in the shower area, mold in the bathroom sink area and that the bathrooms had not been cleaned in some time.

Regarding Allegation #6: Facility has roaches.

This complaint alleges that the facility has roaches. On 03/16/2022 LPA Calderon interviewed A1 for complaint. A1 expressed that there is a roach problem, and that staff and pest control companies spray for pest monthly. A1 expressed that when staff or residents report roaches or other pest to A1 pest control is called and the affected area or areas are addressed. On 03/15/2022 LPA Calderon interviewed R1 for complaint. R1 expressed that roaches are found in the dining room and kitchen area and in the bathrooms. On 03/16/2022 LPA Calderon interviewed R2-R6 for complaint. R2-R6 expressed that R2-R6 have seen roaches in the dining room and bathrooms. R2-R6 expressed that pest control does spray for roaches monthly, but there is a major roach problem. On 03/16/2022 LPA Calderon toured the facility with A1, S1 and LPA Calderon noted trash all over the facility, the kitchen area was not clean, standing water in a kitchen sink was noted, the bathrooms had not been cleaned in some time, there was residents’ clothes on the ground. LPA Calderon noticed roaches in the kitchen area and in the bathrooms.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 12
Control Number 11-AS-20220307102218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ORANGE COMMUNITY CARE
FACILITY NUMBER: 197803389
VISIT DATE: 08/25/2023
NARRATIVE
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Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegation of Administrator absent from the facility, Staff do not provide a safe and healthful environment, Residents clothing are not cleaned, Facility is in disrepair, Facility has black mold, Facility has roaches is found to be SUBSTANTIATED.

An exit interview was conducted and copy of the Complaint Report and Appeal Rights were provided to the Administrator (Ahmed Saafir).
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 12
Control Number 11-AS-20220307102218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: ORANGE COMMUNITY CARE
FACILITY NUMBER: 197803389
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2023
Section Cited
CCR
85064(e)
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85064Adminstrator Qualifications and Duties(e)The administrator shall be on the premises the number of hours necessary to m
This requirement is not met as evidenced by:
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Administrator will submit a updated LIC500 which will advisd LPA Calderon what days and hours administrator will be working at the facility.
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Based on interview, observation, and record review, the licensee failed to ensure that the administrator is on the premises when the facility opens which poses a risk to residents in care.
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Type B
09/08/2023
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement is not met as evidenced by:
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Administrator will hire more cleaning staff and submit a updated LIC500 wiith cleaning staff times and dates that cleaniing stafff willl be working.
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Based on interview, observation, and record review, the licensee failed to ensure that the facility is safe and healthful for residents in care which poses a health safety risk to residents in care. LPA noted dirty bathrooms, holes in walls, trash on the ground.
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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: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 12
Control Number 11-AS-20220307102218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: ORANGE COMMUNITY CARE
FACILITY NUMBER: 197803389
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2023
Section Cited
CCR
85077(b)
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85077(b) Personal Services, (b) Licensees shall provide basic laundry services, including washing and drying of clients' personal clothing.
This requirement was not met as evidenced by:
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Administratorr wll hire more staff to help clean residents clothes and administrator will provide a cleaning schedual for residents clothes.
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Based on interview, observation, and record review, the licensee failed to ensure that the facility is cleaning residents dirty clothes weekly which poses a health risk to residents in care.
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Type B
09/08/2023
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement is not met as evidenced by:
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Administrator willl provide repair orders that prove that the facilty is being fixed to LPA Calderon.
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Based on interview, observation, and record review, the licensee failed to ensure that the facility is in repaired condition, broken bathroom mirrors, holes in walls, broken bathroom lights, leaking bathroom faccets are replaced which poses a health and safety 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.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 12
Control Number 11-AS-20220307102218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: ORANGE COMMUNITY CARE
FACILITY NUMBER: 197803389
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2023
Section Cited
CCR
87303(a)(1)
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2
3
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5
6
7
87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times...(1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by:

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Administrator will provide proof that all bathrooms are clean and free of mold.
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Based on interview, observation, and record review, the licensee failed to ensure that the facility bathrooms are free of mold and are safe and healthful for residents, which poses a health and safety risk to residents in care.
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Type B
09/08/2023
Section Cited
CCR
80087(a)(1)
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5
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80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1) The licensee shall take measures to keep the facility free of roaches and other insects.his requirement is not met as evidenced by:

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Administrator will provide LPA, pest control report for the elimination of roaches, from the facility, and conduct a staff training informing all staff at the facility of the procedures of the elimination plan of roaches in the facility by POC date of 09/08/2023
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Based on interview, observation, and record review the licensee failed to ensure that the facility is free of roaches as LPA Calderon witnessed roaches in the kitchen and bathrooms which posed a potential health 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.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 8 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/07/2022 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20220307102218

FACILITY NAME:ORANGE COMMUNITY CAREFACILITY NUMBER:
197803389
ADMINISTRATOR:SAAFIR, AHMEDFACILITY TYPE:
735
ADDRESS:2103 ORANGE AVENUETELEPHONE:
(562) 599-0856
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:36CENSUS: 34DATE:
08/25/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:MANAGER NATE STOCKARDTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
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9
Staff speak inappropriately to residents
Staff do not serve nutritious meals
Staff withheld residents money
Facility has rats
INVESTIGATION FINDINGS:
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5
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7
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13
THIS REPORT SUPERSEDES THE REPORT DATED 03/16/2023 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the Orange Community Care facility on 03/16/2022 and was greeted by Administrator Ahmed Saafir (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

During this investigation, LPA Calderon interviewed A1, S1-S2, R1, R2-R6. This interview was conducted on 3/15/2022, 3/16/2022. On 3/16/2022 LPA Calderon requested copies of the following: staff and residents’ roster, SIR reports (for current complaint), physician’s report (12/24/2020), appraisal/needs and service plan (12/24/2020), psychiatric admission summary (10/09/2019). Reviewed P&I log notes for 5 random, clients (date 01/02/2023 to 01/02/2024)

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 9 of 12
Control Number 11-AS-20220307102218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ORANGE COMMUNITY CARE
FACILITY NUMBER: 197803389
VISIT DATE: 08/25/2023
NARRATIVE
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Regarding Allegation #1: Staff speaks inappropriately to residents.

This complaint alleges that staff speaks inappropriately to residents in care. On 03/16/2022 LPA Calderon interviewed A1 for complaint. A1 expressed that staff do not speak inappropriately to residents in care. A1 expressed that staff treat all residents in a professional manor and if there is a problem with staff, resident can file a complaint to A1. On 03/16/2022 LPA Calderon interviewed S1-S2 for complaint. S1-S2 expressed that no staff ever yells or curses at other residents or other staff. On 03/15/2022 LPA Calderon interviewed R1 for complaint. R1 expressed that staff has yelled at R1 and cursed at R1 and that R1 has made a complaint to A1. R1 expressed that A1 has not addressed the issue with staff or R1 concerns. On 03/16/2022 LPA Calderon interviewed R2-R6 for complaint. R2-R6 expressed that R2-R6 have no issues with how staff speaks to R2-R6 and that no staff has ever yelled or cursed at R2-R6. R2-R6 expressed that if staff had yelled or cursed at a resident R2-R6 would inform the administrator. On 03/16/2022 LPA Calderon toured the facility with A1, S1. LPA Calderon noted interactions between staff and residents and all conversations were professional.

Regarding Allegation 2: Staff do not serve nutritious meals.

This complaint alleges that staff do not serve nutritious meals. On 03/16/2022 LPA Calderon interviewed A1 for complaint. A1 expressed that the kitchen staff does serve nutritious meals every day to residents in care 3 times per day and that kitchen staff post a meal plan weekly for residents’ review. On 03/16/2022 LPA Calderon interviewed S1 for complaint. S1 expressed that staff does serve nutritious meals to residents in care. S1 expressed that staff serves 3 meals per day and provides snacks to residents. S1 expresses all meals are served in the dining room and no resident has complained to S1 regarding the meals being served. On 03/15/2022 LPA Calderon interviewed R1 for complaint. R1 expressed that staff do not provide nutritious meals for residents in care. R1 expressed that staff serves the same meals every day and the food are not good for residents. On 03/16/2022 LPA Calderon interviewed R2-R6 for complaint. R2-R6 expressed that kitchen staff does provide 3 meals to residents per day and that the food served is fine. R2-R6 expressed that they do not have any issues with food served by kitchen staff. On 03/16/2022 LPA Calderon toured the facility with A1, S1. LPA Calderon noted around lunch time that the dinning room was filled with residents and all residents appeared to enjoy the food that was being served by kitchen staff.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 10 of 12
Control Number 11-AS-20220307102218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ORANGE COMMUNITY CARE
FACILITY NUMBER: 197803389
VISIT DATE: 08/25/2023
NARRATIVE
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Regarding Allegation #3: Staff withheld residents’ money.

This complaint alleges that staff withheld residents’ money. On 03/16/2022 LPA Calderon interviewed A1 for complaint. A1 expressed that staff does manage resident’s money and that residents have their money given to them weekly or until when residents run out of money. A1 expressed that R1 runs out of money and then request money R1 does not have. On 03/16/2022 LPA Calderon interviewed S1 for complaint. S1 expressed that each resident has money deposited into their account by different agencies and depending on the residents account balance and depending on if the resident is conserved there is a certain amount of money that is given to the residents daily. S1 expressed that accurate records are kept, and no resident is refused the money that is owed to them daily. On 03/15/2022 LPA Calderon interviewed R1 for complaint. R1 expressed that staff refuses to give R1 money that is owed to R1. On 03/16/2022 LPA Calderon interviewed R2-R6 for complaint. R2, R4 expressed they manage their own money. R3, R6 expresses that they have no issues with staff taking care of their money. On 03/16/2022 LPA Calderon toured the facility and noted residents lining up near the office to be given money from the facility staff. Reviewed P&I log notes for 5 clients (date 01/02/2023 to 01/02/2024). Log notes accurate and no errors found.

Regarding Allegation #4: Facility has rats.

This complaint alleges that the facility has rats. On 03/16/2022 LPA Calderon interviewed A1 for complaint. A1 expressed that there are no rat issues for the facility and pest control does set traps if any resident or staff reports seeing rats. On 03/16/2022 LPA Calderon interviewed S2 for complaint. S2 expressed that S2 cleans the facility every day and has not seen any rats in the facility. S2 expressed to have seen pest control set traps and no rats were caught. On 03/15/2022 LPA Calderon interviewed R1 for complaint. R1 expressed that R1 has seen rats in the dining room area and R1 has complained to A1. R1 expressed that A1 has done nothing about the rats in the dining room. On 03/16/2022 LPA Calderon interviewed R2-R6 for complaint. R2, R4, R6 expressed to have not seen any rats in the facility. R3 expressed to have seen a rat in the dining room area. On 03/16/2022 LPA Calderon toured the facility with A1, S1. LPA Calderon toured all common areas to include the dining room, kitchen, storge areas. LPA Calderon noted trash all over the facility, but LPA Calderon did not see any rats in the common areas, kitchen, or dining rooms.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 11 of 12
Control Number 11-AS-20220307102218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ORANGE COMMUNITY CARE
FACILITY NUMBER: 197803389
VISIT DATE: 08/25/2023
NARRATIVE
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Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegation of Staff speak inappropriately to residents, Staff do not serve nutritious meals, Staff withheld resident’s money, Facility has rats is found to be UNSUBSTANTIATED.

An exit interview was conducted and copy of the Complaint Report was provided to the Administrator Ahmed Saafir.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 12 of 12