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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000870
Report Date: 03/14/2023
Date Signed: 03/14/2023 12:10:26 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
05/12/2022 and conducted by Evaluator Rosie Quiroz
COMPLAINT CONTROL NUMBER: 22-AS-20220512154821
FACILITY NAME:QUAIL HOMEFACILITY NUMBER:
306000870
ADMINISTRATOR:RAFAEL A. TORRESFACILITY TYPE:
735
ADDRESS:128 N. QUAIL LANETELEPHONE:
(714) 639-6947
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:6CENSUS: 4DATE:
03/14/2023
UNANNOUNCEDTIME BEGAN:
11:33 AM
MET WITH:Pedrito Pilien, Staff, Elizabeth Pilien and Rafael Torres, Licensee/AdministratorTIME COMPLETED:
11:59 AM
ALLEGATION(S):
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Staff is Verbaly abusing resident.
INVESTIGATION FINDINGS:
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 On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz made an unannounced visit to deliver findings regarding the allegation listed above. LPA Quiroz was greeted and met with Staff Elizabeth and Pedrito Pilien. LPA Quiroz called Licensee/Administrator (L/AD) Rafael Torres upon arrival to the facility. (L/AD) Rafael Torres arrived to the facility at 11:04a.m.
LPA Quiroz conducted ten day inspection visit on 5/17/2022 and a follow up visit on 6/28/2022. During the course of the investigation, LPA Quiroz conducted interviews with interviewees consisting of staff, clients and other witnesses and reviewed the following for 4 of 4 clients in care but not limited to: Physician reports and Individual Program Plannings (IPP)s.
During the course of the investigation, six of nine interviewees corroborated with the allegation "Staff is verbally abusing resident." Four of four clients in care indicated Staff 1(S1) speaks in loud tone of voice to clients in care.
CONTINUED ON NEXT PAGE...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
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 3
Control Number 22-AS-20220512154821
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: QUAIL HOME
FACILITY NUMBER: 306000870
VISIT DATE: 03/14/2023
NARRATIVE
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Based on the preponderance of evidence gathered through multiple interviews with interviewees the allegation "Staff is Verbaly abusing resident," has been met; Therefore, the allegation listed above is deemed to be SUBSTANTIATED. The Facility Staff failed to keep the clients in care free of verbal abuse.

The facility is being cited per Title 22, Division 6 of the California Code of Regulations. (SEE LIC 809-D)

An exit interview was conducted with (L/AD) Rafael Torres and a copy of this report, along with LIC9099-D, Appeal Rights were provided at exit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20220512154821
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: QUAIL HOME
FACILITY NUMBER: 306000870
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2023
Section Cited
CCR
80072(a)(3)
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Personal Rights-80072(a)(3):(a)Except for children’s residential facilities,each client shall have personal rights which include, but are not limited to, the following:(3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, CONTINUED...
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L/AD Rafael Torres will read and understand CCR80072 and provide training to staff working at the facility identified on LIC 500 and submit proof of training by 3/17/2023.
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CONT...mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions...This requirement was not met as evidenced by: During the course of the investigation 4 of 4 clients corroborated with allegation "Staff is verbally abusing resident."
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This poses an immediate 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: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3