306002482-6-20-2024-22-AS-SSAS-D6F2L4-20240620172856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002482
Report Date: 06/20/2024
Date Signed: 06/20/2024 12:08:32 PM

Unsubstantiated

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
04/16/2024 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240416145901

FACILITY NAME:	CAREWELL MANOR		FACILITY NUMBER:	306002482
ADMINISTRATOR:	CAROL WILSON		FACILITY TYPE:	740
ADDRESS:	3330 W. STONYBROOK DRIVE		TELEPHONE:	(714) 827-8520
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	6	CENSUS: 2	DATE:	06/20/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Carol Wilson, Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Administrator did not treat residents with dignity and respect.

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the allegation listed above. LPA was greeted and granted entry by facility staff after explaining the reason for the visit. Administrator Carol Wilson was notified of the visit and read the findings via telephone before giving permission to staff to sin on her behalf

The initial complaint investigation took place on April 22, 2024. During the visit, LPA conducted a tour of the physical plant. LPA then requested and reviewed the records and hospice file for one specific facility resident. Three staff interviews, one witness interview and one resident interview were additionally conducted or attempted during the facility visit. The contact information for additional witnesses was provided for use at a later date.
Two additional witness interviews were conducted via telephone on June 14, 2024.
CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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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Control Number 22-AS-20240416145901

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: CAREWELL MANOR	FACILITY NUMBER: 306002482
	VISIT DATE: 06/20/2024

NARRATIVE

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CONTINUED FROM FORM LIC9099
On April 10, 2024, a verbal argument occurred between the facility's administrator and a visitor to the facility after the visitor requested access to one of the resident's hospice file and was denied access to the documents. Two additional visitors were present at the time of the incident and were later interviewed by LPA. A witness interview confirmed that the facility's administrator had received clear instructions to limit access to certain documents, as it was stated to have occurred on the day of the verbal confrontation. Both witnesses present described the administrator as experiencing visible frustration at the repeated requests to disregard the instructions in question, however both witnesses also denied having heard any insults or inappropriate language being used at the time, either directed at facility visitors or in the presence of facility residents. Two video files timestamped on the same day and reviewed by LPA also failed to provide any evidence of inappropriate or injurious language being used on that day.

As a result, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

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