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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001789
Report Date: 01/25/2023
Date Signed: 01/25/2023 11:11:25 AM

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
09/03/2020 and conducted by Evaluator Patricia Velazquez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20200903112406
FACILITY NAME:MOORE VILLAGEFACILITY NUMBER:
306001789
ADMINISTRATOR:MINDY ANDREWSFACILITY TYPE:
735
ADDRESS:403 N. SUSAN STREETTELEPHONE:
(714) 480-0025
CITY:SANTA ANASTATE: ZIP CODE:
92703
CAPACITY:42CENSUS: 42DATE:
01/25/2023
UNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Mindy Andrews - Administrator
John Baxter - Facilities and Contracts Manager		TIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Facility is preventing the client from receiving money via mail
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced subsequent complaint visit to deliver the findings of the investigation into the above allegation. LPA Velazquez was allowed entry into the facility and met with Facilities and Contracts Manager John Baxter and explained the purpose of the visit. Administrator Mindy Andrews arrived shortly after LPA's arrival and assisted with the visit.

On today's visit LPA Velazquez conducted interviews with clients and staff. LPA also reviewed and requested copies of facility and client records. During the course of the investigation the following was revealed: LPAs Ruth Martinez and Patricia Velazquez reviewed facility records and obtained copies of pertinent documents. LPA Velazquez conducted interviews with clients and staff. Six of seven individuals interviewed indicated clients can and do receive money in the mail and could not corroborate the above allegation. Seven of seven individuals interviewed also described the process of notifying clients that they have received mail and then the client picks up their mail at the Reception Office. The records reviewed included Client Identification and
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Patricia Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
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-20200903112406
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: MOORE VILLAGE
FACILITY NUMBER: 306001789
VISIT DATE: 01/25/2023
NARRATIVE
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Emergency Information, Residential Service Agreements, Physician's Reports, Relapse Prevention Plan and Agreement, Appraisal Needs and Services Plans, and House Rules of Conduct.

Based on the observations made, interviews which were conducted and the records that were reviewed, 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, therefore the following allegation: Facility is preventing the client from receiving money via mail is deemed UNSUBSTANTIATED.

An exit interview was conducted with Administrator Mindy Andrews and a copy of this report along with the LIC 811 was provided at the time of this visit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Patricia Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2