306002275-1-3-2025-22-AS-AORZ-DDELRH-20250130075908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002275
Report Date: 01/03/2025
Date Signed: 01/03/2025 03:51:27 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 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
12/27/2024 and conducted by Evaluator Dwayne L Mason

COMPLAINT CONTROL NUMBER: 22-AS-20241227142941

FACILITY NAME:	ANGELS HOME		FACILITY NUMBER:	306002275
ADMINISTRATOR:	RAFAEL A. TORRES		FACILITY TYPE:	735
ADDRESS:	12061 LORALEEN STREET		TELEPHONE:	(714) 537-3413
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY:	6	CENSUS: 3	DATE:	01/03/2025
		UNANNOUNCED	TIME BEGAN:	01:51 PM
MET WITH:			TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Facility did not ensure that there is adequate staff.

INVESTIGATION FINDINGS:

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This unannounced investigation inspection by Licensing Program Analyst (LPA) Dwayne Mason Jr. is being conducted to conclude this agency’s investigation into the complaint allegation(s) mentioned above. LPA arrived at the facility and was greeted by facility staff. LPA met with Licensee Rafael Torres and explained the nature of the inspection.

The department received a complaint on 12/27/2024 alleging the facility did not ensure that there is adequate staff. During the investigation, the department interviewed Licensee, staff and clients in care.

(continued on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025

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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Control Number 22-AS-20241227142941

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ANGELS HOME	FACILITY NUMBER: 306002275
	VISIT DATE: 01/03/2025

NARRATIVE

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(continued from LIC9099)

On 1/3/2025 LPA conducted a visit to the facility to initiate investigation into the above allegation. LPA obtained copies of the resident roster, staff roster, physician's reports and individual program plans (IPPs). LPA reviewed the physician's reports for all three clients (C1, C2, C3). LPA observed all clients are able to care for all their own personal needs. LPA also observed no clients require constant medical supervision. LPA reviewed the IPPs for all three clients (C1, C2, C3). LPA observed none of the clients require one-on-one care staff or one-on-one behavioral staff.

LPA conducted interviews with Licensee, staff (S1) and clients (C1, C2, C3). Based on interviews conducted, 2 out of 3 clients stated the facility has never left the clients alone at the facility and that they have enough staff. Licensee and S1 denied the allegations.

Based on observations, interviews conducted and records reviewed there is insufficient evidence to support the allegation of "Facility did not ensure that there is adequate staff." Although the allegation(s) may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted, and this report was reviewed with facility staff. A copy of this LIC-9099 was provided to the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025

LIC9099 (FAS) - (06/04)

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