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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300607404
Report Date: 10/15/2024
Date Signed: 10/15/2024 02:07:49 PM

Substantiated


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
10/07/2024 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20241007152032
FACILITY NAME:LAURENCE RESIDENTIAL CAREFACILITY NUMBER:
300607404
ADMINISTRATOR:LAURENCE, VERNELLFACILITY TYPE:
735
ADDRESS:3722 S. ROSS ST.TELEPHONE:
(714) 662-7771
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY:6CENSUS: 0DATE:
10/15/2024
UNANNOUNCEDTIME BEGAN:
07:13 AM
MET WITH:Licensee Vernell LaurenceTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Facility is not clean and in good repair
Inside of facility is not free of obstructions
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced inspection visit to initiate complaint investigation into the above allegations. LPA met with Licensee/ Administrator Vernell Laurence and staff Patricia Ingram and stated the purpose of the visit.

During the visit, LPA conducted a tour of the facilities inside and outside physical plant. LPA made observations and conducted interviews with staff. During time of visit, facility had no clients in care and are looking to close.

On October 7, 2024 the department received a cross report from an Agency regarding visits that were conducted to facility back on May 16, 2024 and August 15, 2024. Citations were issued at the time of that visit.
Based off observations, interviews and record review, regarding allegation Facility is not clean and in good repair, upon inspection by department the following was observed
CONTINUED ON 809C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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 7
Control Number 22-AS-20241007152032
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: LAURENCE RESIDENTIAL CARE
FACILITY NUMBER: 300607404
VISIT DATE: 10/15/2024
NARRATIVE
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In regards to allegation facility is not clean and in in good repair, LPA Tirre observed that facility had clutter on dining room table, clutter in upstairs bedrooms. LPA observed bags of clothes for donation in upstairs bedrooms. LPA observed food crumbs on kitchen floor. LPA observed living room had a pet pee pad in middle of living room floor. Pee pad did not have any markings. LPA observed a few cat litter boxes located on side of staircase on first floor.

Regarding allegation inside of facility is not free of obstructions, LPA did not observe any obstructions in hallways, entryways of rooms and stairway. LPA observed front door has two doors that open to facility and one door has an antique hat tree in front of one side of door located closest to living room window. Facility.

Based off information gathered the following allegations Facility is not clean and in good repair and inside of facility is not free of obstructions have met the preponderance of evidence standard deeming the allegations as SUBSTANTIATED.

For today's visit, citations were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with AD Laurence and S1 Ingram. A copy of this report was provided and explained.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 22-AS-20241007152032
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: LAURENCE RESIDENTIAL CARE
FACILITY NUMBER: 300607404
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/22/2024
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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As plan of correction (POC) Licensee to keep facility in good repair and provide proof of clutter removal via POC date. Facility is in process of closure and last client in care was 9/26/24.
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This requirement is not met as evidence by: based observations of clutter throughout the house, food crumbs on floor and pet pee pad in middle of living room floor. This poses a potential health & safety risk to clients in care
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Type B
10/22/2024
Section Cited
CCR
87307(d)(6)
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87307 Personal A ccomodations & services
(d) the following space and safety provisions shall apply to all facilities. (6) all outdoor and indoor passageways and stair ways shall be kept free of obstruction.
This requirement is not met as evidence by :based observation of furniture placed
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Facility POC is to move furmiture by POC due date and to provide by close of business date. Facility is in process of closure and last client in care was 9/26/24.
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in front of one side of door. This poses a potential 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: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
10/07/2024 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20241007152032

FACILITY NAME:LAURENCE RESIDENTIAL CAREFACILITY NUMBER:
300607404
ADMINISTRATOR:LAURENCE, VERNELLFACILITY TYPE:
735
ADDRESS:3722 S. ROSS ST.TELEPHONE:
(714) 662-7771
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY:6CENSUS: 0DATE:
10/15/2024
UNANNOUNCEDTIME BEGAN:
07:13 AM
MET WITH:Licensee, Vernell LaurenceTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Facility is not free of insects
Facility does not have an adequate supply of food
Facility refrigerator is not clean
Staff are not properly trained
Facility does not maintain proper personnel records
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced inspection visit to initiate complaint investigation into the above allegations. LPA met with Licensee/ Administrator Vernell Laurence and staff Patricia Ingram and stated the purpose of the visit.
During the visit, LPA conducted a tour of the facilities inside and outside physical plant. LPA made observations and conducted interviews with staff. During time of visit, facility had no clients in care and are looking to close.

On October 7, 2024 the department received a cross report from an Agency regarding visits that were conducted to facility back on May 16, 2024 and August 15, 2024. Citations were issued at the time of that visit.

Based off observations, interviews and record review, regarding allegations, upon inspection by department the following was observed CONTINUED ON 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 22-AS-20241007152032
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: LAURENCE RESIDENTIAL CARE
FACILITY NUMBER: 300607404
VISIT DATE: 10/15/2024
NARRATIVE
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Regarding Allegation Facility is not free of insects, during investigation LPA did not observe any insects, bugs or fleas inside facility. LPA observed two indoor cats and dog roaming around in home and did not see visible fleas on pets. LPA observed documentation dated September 19, 2024 from Western Exterminating company stating service was completed for ants at front living room window. LPA did not observe any ants in window.

Regarding Allegation Facility does not have adequate supply of food, LPA observed facility has two fridges located inside kitchen area. One fridge was observed as empty and unplugged. Licensee mentioned this fridge used to be main fridge Clients would have their food located in. Licensee confirmed that last client was present inside facility as of September 26, 2024. LPA observed second fridge had supply of perishables and non-perishable foods. LPA observed facility garage had supply of canned goods and a freezer with additional food.

Regarding allegation facility refrigerator is not clean, LPA observed the following , facility has two refrigerators located in kitchen. One fridge has adequate supply of food and is clean inside and out. The other fridge is empty and has some visible marking's inside freezer area. Fridge does not smell and is not in use.

Regarding allegation staff are not properly trained, LPA reviewed staff files and made observations that Staff 1 had 20 hours of RCFE (Residential Care For Elderly) Training and 20 hours of ARF (Adult Residential Facility) Training. Staff 2 had total of 35 hours combined RCFE & ARF training.

Regarding Allegation facility does not maintain proper personnel records. After record review of facility personnel files, LPA observed that facility had the following paperwork maintained in Personnel files at time of visit: staff First Aid and CPR certificate, fingerprints clearance, Education, Medical Training and TB (tuberculosis) Test. LPA observed that Personnel files were present in facility office.

Based off information received, the complaint allegations Facility is not free of insects Facility does not have an adequate supply of food, Facility refrigerator is not clean, Staff are not properly trained, Facility does not maintain proper personnel records is deemed UNSUBSTANTIATED, meaning although the allegations may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violations occurred as reported.

An exit interview was conducted with staff and reported provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7