306001408-10-10-2024-22-AS-AORZ-DA6LAD-20241018083459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306001408
Report Date: 10/10/2024
Date Signed: 10/10/2024 01:09:42 PM

Unfounded

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
04/26/2023 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20230426155340

FACILITY NAME:	PARK PLAZA		FACILITY NUMBER:	306001408
ADMINISTRATOR:	BENJAMIN DAVIS		FACILITY TYPE:	740
ADDRESS:	620 S. GLASSELL STREET		TELEPHONE:	(714) 997-5355
CITY:	ORANGE	STATE: CA	ZIP CODE:	92866
CAPACITY:	115	CENSUS: 97	DATE:	10/10/2024
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Ben Davis		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not provide adequate supervision resulting in resident wandering away from facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to continue the investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility, interviewed Administrator as well as reviewed and obtained pertinent documentation such as physician report. Regarding the allegation that staff did not provide adequate supervision resulting in resident wandering away from facility, the investigation revealed the following: Resident 1 (R1) admitted into the facility on 03/31/2023 with a diagnosis of hypothyroidism. On 04/24/2023, Resident was discovered in the facility parking lot at approximately 3:00 AM after the exit door alarm had triggered. Resident was brought back into the facility with no injuries noted. Physician report dated 03/27/2023 indicated no cognitive impairment and resident is able to leave the facility unassisted. Based on interviews conducted and record review, the allegation is deemed unfounded, meaning the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to facility representative.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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