300600977-10-27-2023-22-AS-MSTC-CXS5Q9-20231120190906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300600977
Report Date: 10/27/2023
Date Signed: 10/27/2023 01:31:21 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
07/19/2023 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230719155923

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: 191	DATE:	10/27/2023
		UNANNOUNCED	TIME BEGAN:	10:34 AM
MET WITH:	Rob Goerzen- CEO/President		TIME COMPLETED:	01:34 PM

ALLEGATION(S):

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Staff are not providing adequate food service to residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced to continue the investigation and to deliver the findings into the above allegation. LPA explained the reason for the visit and reviewed the allegation with Chief Executive Officer/President Rob Goerzen.

On July 27, 2023, the complaint investigation was commenced by LPA Andrea Mendivil which involved staff interviews, a kitchen tour, and obtaining copies of facility records. On August 24, 2023, LPA Jessica Cho continued resident/staff interviews and obtained copies of pertinent facility/resident records. Supplemental records along with the staff interviews were obtained by LPA Cho including a tour of the kitchen/dining room on August 31, 2023. On today’s date, LPA interviewed one staff and observed the lunch service. The following was revealed during the course of the investigation:

It is alleged that the staff are not providing adequate food service to the residents in care.

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: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

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 4

Control Number 22-AS-20230719155923

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: 10/27/2023

NARRATIVE

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Per interviews conducted on August 23, 2023, twelve out of the twelve residents indicated that three meals including snacks were offered daily, and that they never experienced a day without a meal. All twelve residents indicated that the food was nutritionally balanced, was of good quality, and portion size. However, two out of the twelve residents indicated that their meal wait times were inconsistent on or before August 2023. Six out of the six staff interviewed indicated that no meals have ever been missed. Two of the five staff indicated that the kitchen was short staffed to meet the demands resulting in the delay in serving. LPA was able to verify on today’s date that the food was of good portion, nutritionally balanced, and served by at least 4 servers on time in between 11:00am-11:15am.

Based on LPA’s observations, interviews, 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 violation did or did not occur, therefore the allegation: Staff are not providing adequate food service to residents in care is deemed UNSUBSTANTIATED.

An exit interview was conducted with Chief Executive Officer/President Rob Goerzen, and a copy of this report including the LIC9099-C were provided 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: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
07/19/2023 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230719155923

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: 191	DATE:	10/27/2023
		UNANNOUNCED	TIME BEGAN:	10:34 AM
MET WITH:	Rob Goerzen- CEO/President		TIME COMPLETED:	01:34 PM

ALLEGATION(S):

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Staff are not properly storing food.

INVESTIGATION FINDINGS:

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13

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced to deliver the findings into the above allegation. LPA explained the reason for the visit and reviewed the allegation with Chief Executive Officer/President Rob Goerzen.

On July 27, 2023, the complaint investigation was commenced by LPA Andrea Mendivil which involved staff interviews, a kitchen tour, and obtaining copies of facility records. On August 24, 2023, LPA Jessica Cho continued resident/staff interviews and obtained copies of pertinent facility/resident records. Supplemental records along with the staff interviews were obtained by LPA Cho including a tour of the kitchen/dining room on August 31, 2023. The following was revealed during the course of the investigation:

It is alleged that the staff are not properly storing food. On August 31, 2023, LPA Cho toured the kitchen and dining area alongside Director of Residential Services (DRS) Stephanie Jukic. LPA observed that the kitchen staff adhered to correct food storage procedures through the following methods:

Unfounded

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: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20230719155923

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: 10/27/2023

NARRATIVE

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The kitchen was clean and organized, perishable items were refrigerated and sectioned off to prevent food spoilage and cross-contamination, items were properly sealed, labeled, and dated to monitor the food’s expiration. Four out of the five staff denied the allegation while one out of the five staff was unable to provide details as they were uninformed of the details of the dining operation.

This agency has investigated the complaint and based on the observations made, interviews which were conducted, and the records that were reviewed, the following allegation: Staff are not properly storing food is deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Chief Executive Director/President Rob Goerzen, and a copy of this report along with the LIC9099-C were provided 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: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4