300600977-8-24-2023-22-AS-MVAO-CW5U8V-20230929152209

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300600977
Report Date: 08/24/2023
Date Signed: 08/24/2023 01:36:36 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/03/2023 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230803132853

FACILITY NAME:	TOWN & COUNTRY		FACILITY NUMBER:	300600977
ADMINISTRATOR:	STEPHANIE JUKIC		FACILITY TYPE:	741
ADDRESS:	555 E. MEMORY LANE		TELEPHONE:	(714) 547-7581
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92706
CAPACITY:	328	CENSUS: 185	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Stephanie Jukic- Director of Residential Services Nikka Solomon- Director of Health & Wellness		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff does not provide residents with dignity and respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose to deliver the findings into the above allegation. LPA met with Director of Residential Services Stephanie Jukic and Director of Health & Wellness Nikka Solomon and explained the reason for the visit.

On August 10, 2023, the complaint investigation visit was initiated. During the course of the initial visit, LPA interviewed residents and staff and obtained copies of pertinent facility and resident records which revealed the following:

It is alleged that the staff does not provide residents with dignity and respect. It was determined based on the interviews conducted that seven out of the seven individuals could not corroborate with the allegation. Additionally, one out of the seven individuals interviewed has personally experienced being treated disrespectfully and without dignity; however, was unable to specify the details of the mistreatment and the name of the individual in question.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230803132853

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: TOWN & COUNTRY	FACILITY NUMBER: 300600977
	VISIT DATE: 08/24/2023

NARRATIVE

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Based on the interviews which were conducted and the records that were reviewed, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation: Staff does not provide residents with dignity and respect is deemed UNSUBSTANTIATED.

An exit interview was conducted with Director of Residential Services Stephanie Jukic and Director of Health & Wellness Nikka Solomon, and a copy of this report along with the LIC9099-C were provided to the Director of Residential Services via email at the end of the visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC9099 (FAS) - (06/04)

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