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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001818
Report Date: 07/14/2023
Date Signed: 07/14/2023 03:25:28 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
07/07/2023 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230707101059
FACILITY NAME:D'BEST CAREFACILITY NUMBER:
306001818
ADMINISTRATOR:MA DINAH DELA CRUZFACILITY TYPE:
740
ADDRESS:3608 W. ASH AVENUETELEPHONE:
(714) 278-0528
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:6CENSUS: 3DATE:
07/14/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Lucille Nofies-Caregiver, Ma Dinah Dela Cruz-AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility is clutter and unsanitary
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and initially met with Caregiver Lucille Nofies and LPA explained the reason for the visit. Administrator (AD) Ma Dinah Dela Cruz arrived shortly after.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Two of six individuals interviewed corroborated the allegation.Two of six individuals interviewed denied the allegation and the remaining two individuals could not be qualified to answer questions. In the kitcken refrigerator LPA observed food particles and brown and red discoloration on the inside base of the container contaning produce. At 9:11 AM LPA observed brown and red discoloration on the interior base of the refrigerator and the floor right in front of the refrigerator.
CONTINUED ON LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
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 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
07/07/2023 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230707101059

FACILITY NAME:D'BEST CAREFACILITY NUMBER:
306001818
ADMINISTRATOR:MA DINAH DELA CRUZFACILITY TYPE:
740
ADDRESS:3608 W. ASH AVENUETELEPHONE:
(714) 278-0528
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:6CENSUS: 3DATE:
07/14/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Lucille Nofies-Caregiver, Ma Dinah Dela Cruz-AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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9
Female non-staff is sleeping in common area (living room couch)
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and initially met with Caregiver Lucille Nofies and LPA explained the reason for the visit. Administrator (AD) Ma Dinah Dela Cruz arrived shortly after.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Four of six individuals interviewed corroborated the allegation. The remaining two individuals could not be qualified to answer questions. During the course of the interviews AD stated that Staff 1 (S1) was not associated to the facility because she did not know if S1 would be working at the facility long term. It was reported via interviews by Resident 1 (R1) that a female not performing caregiver duties was sleeping in a couch in the living room for about three weeks. It was reported via interviews that S1 worked at the facility for two weeks but that she ended being fired.
CONTINUED ON LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 22-AS-20230707101059
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: D'BEST CARE
FACILITY NUMBER: 306001818
VISIT DATE: 07/14/2023
NARRATIVE
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During the investigation LPA reviewed documents including the Licensing Information System (LIS) Facility Personnel Report Summary dated 07/12/23. Per LIS Facility Personnel Report Summary S1 is not associated and/or cleared to work at the facility.

Based on LPA observations and the interviews which were conducted, the preponderance of evidence standard has been met, therefore the following allegation: Female non-staff is sleeping in common area (living room couch) is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D

A $500 Civil Penalty was issued.

AD agreed to email the Physician Report (LIC602) and Admission Agreement for three residents in care by 07/17/23.

An exit interview was conducted with AD Dela Cruz and a copy of this report along with the Appeal Rights were provided at the time of this visit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 22-AS-20230707101059
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: D'BEST CARE
FACILITY NUMBER: 306001818
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/14/2023
Section Cited
CCR
87355(e)(1)
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87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee to verify staff is associated and/or cleared on Guardian prior to their first day working at the facility. LPA observed that S1 is no longer working at the facility.
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This requirement is not met as evidence by: Based on interviews and AD admission S1 began working at the facility prior to being Associated/Eligible to work at the facility.
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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.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 22-AS-20230707101059
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: D'BEST CARE
FACILITY NUMBER: 306001818
VISIT DATE: 07/14/2023
NARRATIVE
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In the kitchen LPA observed that the countertop tile is missing grout and therefore is growing mold.
At 9:18 AM LPA tour the back yard and observed a ladder, boxes full of clothes, a bicycle, a treadmill, and plastic bin containers stack on top of each other. On the side of the house leading to the exit gate LPA observed empty cardboard boxes stack on top of each other, a ladder, a rug, a portable propane tank, paint containers on top of each other and plastic bags fill with litter.

Based on LPA observations and the interviews which were conducted, the preponderance of evidence standard has been met, therefore the following allegation: facility is clutter and unsanitary is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D

An immediately $250 Civil Penalty was issued today for a repeat violation cited on 08/25/22.

An exit interview was conducted with AD Dela Cruz and a copy of this report along with the Appeal Rights were provided at the time of this visit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20230707101059
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: D'BEST CARE
FACILITY NUMBER: 306001818
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by: LPA
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Licensee to sanitize and clean the kitchen refrigerator and countertop tile. Licensee to declutter the back yard and side leading to the exit gate. Licensee to email LPA proof by POC due date.
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observed food particles and brown and red discoloration on the inside base of the refrigerator container contaning produce. LPA also observed clutter on the back yard and on the side of the house leading to the exit gate. LPA observed that the kitchen countertop tile is growing mold.
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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.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6