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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000870
Report Date: 05/31/2023
Date Signed: 05/31/2023 01:17:40 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
05/04/2023 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230504100118
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: 1DATE:
05/31/2023
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Elizabeth Pilien TIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Staff do not provide proper food service to clients in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to deliver findings on the complaint allegation above. LPA Haley was allowed into the facility and explained the reason for the visit upon entry. After entering the facility, LPA checked the facilities food supply and observed an adequate supply of food items that meet regulation requirements.

Regarding the Allegation: Staff do not provide proper food service to clients in care

During the complaint investigation, LPA Haley made two unannounced visits to the facility. The initial visit was completed May 10, 2023, and a follow up visit was conducted May 24, 2023. LPA observed an adequate food supply that satisfied regulation requirements during both visits. During the visits, interviews were conducted with the facility Administrator (AD) Rafael Torres, 2 caregivers, and all 3 clients. LPA Haley contacted a witness, but the witness could not be reached, and did not return LPA's phone call to provide information regarding the complaint allegation.
Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
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 2
Control Number 22-AS-20230504100118
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: 05/31/2023
NARRATIVE
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Based on the information gathered during the investigation, and interviews, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2