<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001396
Report Date: 11/21/2024
Date Signed: 11/21/2024 06:12:51 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
11/19/2024 and conducted by Evaluator Jerome Haley
COMPLAINT CONTROL NUMBER: 22-AS-20241119085903
FACILITY NAME:ALEXA'S HOMEFACILITY NUMBER:
306001396
ADMINISTRATOR:PATRICIA FESTINFACILITY TYPE:
735
ADDRESS:3117 W. CUBBONTELEPHONE:
(657) 245-3165
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY:6CENSUS: 2DATE:
11/21/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Patricia FestinTIME COMPLETED:
04:59 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to provide a proper notice regarding the facility closure.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA) Jerome Haley made an unannounced visit to begin the investigation into the complaint allegation above. LPA Haley was greeted by staff and explained the reason for the visit upon entry.

Regarding the complaint allegation: Facility failed to provide a proper notice regarding the facility closure.

During the investigation it was discovered a 30-day notice regarding the intent to close the facility “effective immediately” and relocate all clients was written and provide to the Orange County Adult and Senior Care Program Regional Office (ASCP) and the Regional Center of Orange County (RCOC). During an interview with Staff 1 (S1), it was confirmed the letter was written and provided to their ASCP analyst, and RCOC. S1 also confirmed, the 30-day notice was not given to any of the client’s or their family members and/or responsible persons.
Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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 3
Control Number 22-AS-20241119085903
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: ALEXA'S HOME
FACILITY NUMBER: 306001396
VISIT DATE: 11/21/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 During an interview with Witness 1 (W1), it was confirmed as of November 20, 2024 the 30-day notice still had not been provided to any of the clients or their family members and/or responsible persons.

Based on the evidence gathered through interview confirmation and document review, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22.

An exit interview was conducted, and a copy of this report, and appeal rights were provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20241119085903
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: ALEXA'S HOME
FACILITY NUMBER: 306001396
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2024
Section Cited
HSC
1562.1(b)(1)
1
2
3
4
5
6
7
In addition to the notification requirements provided for in Section 1562.2, a licensee of an adult residential facility shall inform a resident and the resident’s representative, if any, of a proposed closure, including whether the licensee intends to sell the property or business, no later than 180 days before its proposed closure, or as soon as practicably possible.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The licensee will inform Regional Center and the Department their intent to rescind the 30-day notice and will submit a new notice to the department for approval. The new notice will meet regulation guidelines and will give the clients and their family members and/or responsible persons at least 90-days to find placement. The POC is due by Monday, November 25, 2024 at 4:00pm.
The licensee will be provided a copy of the regulation section for review.
8
9
10
11
12
13
14
During interviews it was confirmed by more than one individual that the notice of the facility closure was not approved by the department, and not provided to the clients or their family members and/or responsible persons. This poses a potential personal right violation to clients in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3