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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000801
Report Date: 10/26/2022
Date Signed: 10/26/2022 10:17:01 AM

Substantiated


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
07/20/2022 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220720140534
FACILITY NAME:CHAPMAN BOARD & CAREFACILITY NUMBER:
306000801
ADMINISTRATOR:BRYSON NAZARENOFACILITY TYPE:
735
ADDRESS:10811 CHAPMAN AVE.TELEPHONE:
(714) 638-8777
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:49CENSUS: 48DATE:
10/26/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Matthew NazarenoTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Facility is in disrepair
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with Administrator (AD) Matthew Nazareno and explained the reason for today’s inspection. The investigation into the allegation that Facility is in disrepair revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, 1 witness, 1 resident, and 2 staff, and requested and reviewed copies of the resident roster, staff roster, and an Edison Environmental Protection letter dated 08/10/22.

On 07/22/22, LPA inspected the facility and observed a large hole that had been created in the ceiling of a resident room (Room 20) that appeared to be part of some construction work. In interviews, AD stated that there had recently been a leak in the fire sprinkler system in that room. After learning of the leak, AD called Edison Fire Protection, the fire system company, who told AD to have the ceiling and dry wall torn down so their technician can identify and fix the leak.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
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 3
Control Number 22-AS-20220720140534
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: CHAPMAN BOARD & CARE
FACILITY NUMBER: 306000801
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/27/2022
Section Cited
CCR
80087(a)
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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. This requirement was not met as evidenced by:
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AD stated that the ceiling in Room 20 was completely repaired on 10/05/22. On 10/12/22 and during today's inspection, LPA observed and confirmed that the ceiling in Room 20 has been completely repaired.

POC CLEARED
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Based on observations, interviews, and documents, the licensee did not ensure 1 resident room was in good repair for almost 2 months, which poses an immediate personal rights 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: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20220720140534
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: CHAPMAN BOARD & CARE
FACILITY NUMBER: 306000801
VISIT DATE: 10/26/2022
NARRATIVE
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Statements from 1 witness, 1 resident, AD, and 2 staff conflict about how long the facility was aware of the leak before calling Edison Fire Protection. AD followed the instructions from Edison Fire Protection and had the ceiling torn down immediately so the inspection could take place. Prior to 07/22/22, Edison Fire Protection came out to inspect the fire system but referred the job to Edison Environmental Protection because it was outside of their scope of work. AD stated that prior to 08/10/22, Edison Environmental Protection came out and inspected the fire sprinkler system and told AD they could fix the problem and that once the problem had been fixed, the ceiling can be closed back up and repaired. LPA reviewed an Edison Environmental Protection letter dated 08/10/22 that corroborates AD’s statements about the fire sprinkler system, states that Edison Environmental Protection has identified the problem and proposed a solution, and states that Edison Environmental Protection is recommending that the ceiling remain open until all repairs are completed, after which point the ceiling can be closed up and repaired. However, per interviews with AD and 1 witness, Edison Environmental Protection was ready to begin the work immediately after 08/10/22 but the facility did not provide the down payment on the project until 09/29/22, with the work finally starting on 10/04/22. Per AD, there was never any risk of the ceiling collapsing or of physical injury to the residents in the room and Edison Environmental Protection has confirmed this to AD. LPA inspected the ceiling twice and observed that while some insulation is pulled out, the wood and pipes are in their regular locations and the ceiling appears structurally sound. However, due to the facility’s delay in providing the down payment, the ceiling was in disrepair for almost 2 months before the repairs were started, with the residents having to live with an open ceiling and exposed insulation for that period.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3