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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000801
Report Date: 08/02/2023
Date Signed: 08/02/2023 02:23:47 PM

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
07/25/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230725161140
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: 47DATE:
08/02/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Matthew Nazareno, Bryson Nazareno TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff spoke inappropriately to resident.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to begin the investigation into the allegation listed above. LPA was greeted and granted entry by staff. LPA met with Administrator Matthew Nazareno and explained the reason for the visit. LPA toured the facility with staff. Regarding the allegation, facility staff spoke inappropriately to resident, the investigation revealed the following. Facility Staff 1 (S1) denied speaking inappropriately to Client 1 (C1) on July 18, 2023 during a group phone call. 2 out of 3 witnesses interviewed reported C1 was spoken inappropriately to by S1 during the group phone call. Based on the evidence gathered through interviews the preponderance of evidence standard has been met, therefore, the allegation, facility staff spoke inappropriately to resident is Substantiated. Deficiencies are being cited 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.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
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
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
07/25/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230725161140

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: 47DATE:
08/02/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Matthew Nazareno, Bryson Nazareno TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Resident's bedroom is malodorous.
Resident's bedroom has mold.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to begin the investigation into the allegations listed above. LPA was greeted and granted entry by staff. LPA met with Administrator Matthew Nazareno and explained the reason for the visit. LPA toured the facility with staff. The investigation into the allegation, resident's bedroom is malodorous, revealed the following. LPA did not observe any odors in the facility or C1's room or bathroom. LPA observed the toilet in C1's bathroom was slightly tilted. Witnesses interviewed reported no odors in the facility. Based on the evidence gathered the allegation, resdient's bedroom is malodoruous, is deemed unsubstantiated, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Regarding the allegation, resident's bedroom has mold, the investigation revealed the following. LPA toured the facility and observed there is a stain on the ceiling in C1's room. LPA went in the attic and observed there is no leaking water from the sprinkler system and no water damage in the attic above C1's room.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20230725161140
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: 08/02/2023
NARRATIVE
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LPA did not observe any mold in the attic. LPA did not observe any mold in C1's bedroom. C1 and staff reported they have not observed any mold in the facility. Staff reported that all bedrooms in the facility are cleaned weakly, clients interviewed verified this information. Based on the evidence gathered the allegation, resident's bedroom has mold is deemed unsubstantiated, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20230725161140
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: 08/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/03/2023
Section Cited
CCR
80072(a)
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To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by, during a group phone call S1 spoke inappropriately to C1 which was witnessed by 2 individuals.
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Licensee agrees to train all staff regarding personal rights of clients (CCR 80072). Licensee agrees to document proof of training and to forward it to LPA by POC due date.
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This poses an immediate health and safety risk to clients 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: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4