300600977-8-23-2024-22-AS-LMOA-DGXPGJ-20250523111826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300600977
Report Date: 08/23/2024
Date Signed: 08/23/2024 05:04:33 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
08/05/2024 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240805144055

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: 110	DATE:	08/23/2024
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Nikka Solomon		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff may be financially abusing residents
Staff violated residents' personal rights

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced inspection visit to deliver findings for complaint investigation into the above allegations. LPA explained the reason for the visit with Assisted Living Coordinator Nikka Solomon.
During the course of the investigation LPA toured facility, reviewed records, conducted interviews, made visual observations and requested pertinent documentation such as Resident Roster’s, staff roster’s, Physician’s reports, employee handbook, resident care plans, food service invoices and Resident Council meeting notes.

During investigation LPA reviewed facility records and records reviewed revealed that three residents (R1, R2 & R3) recently moved from facilities Assisted Living corridors to Memory Care Unit Grace Gardens. Reviewed Resident Physician’s reports and Care plans confirmed residents R1, R2, & R3 had a proper diagnoses for Memory care placement.
CONTINUED ON 9099C

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

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-20240805144055

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: TOWN & COUNTRY	FACILITY NUMBER: 300600977
	VISIT DATE: 08/23/2024

NARRATIVE

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LPA conducted a record review on facility invoices for grocery and supplies. Records dated from July 5, 2024, to July 23, 2024 from four different vendors revealed that facility is receiving food supply on a weekly basis.

Interviews conducted with staff reveal that twelve of twelve staff confirmed that facility has no issues with finances or utilities. Interviews with Residents confirmed that eight of eight residents have not experienced facility being in disrepair. Eight of eight residents confirmed that no staff have tried persuading residents to move over to Memory care unit Grace Gardens and residents claim no staff have financially abused them.

Eight of eight residents and twelve of twelve staff all confirm that facility is providing residents with three meals daily, providing medications on daily schedule, as well as confirming facility has had no issues with electricity & water.

Interviews with eight of eight residents confirms that residents feel respected, personal rights are being honored and residents appreciate level of care being provided by staff.

Observations made revealed that facility is providing food & beverage, medications, activities, running water, and power. Observations made confirm facility is following infection control policies.

Based on interviews conducted and records reviewed, this agency has investigated the complaint alleging Staff may be financially abusing residents and staff violated residents' personal rights . We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/ or is without reasonable basis.

An exit interview was conducted with facility representative and a copy of this report was reviewed and provided at the time of this visit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC9099 (FAS) - (06/04)

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