306002817-9-8-2023-22-AS-MSTC-CW659L-20230929194541

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002817
Report Date: 09/08/2023
Date Signed: 09/08/2023 11:34:05 AM

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
04/21/2022 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220421143322

FACILITY NAME:	GLORIOUS HOME #2		FACILITY NUMBER:	306002817
ADMINISTRATOR:	PRISCILLA DELAGNEAU		FACILITY TYPE:	740
ADDRESS:	24672 ARGUS DRIVE		TELEPHONE:	(949) 916-2079
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 4	DATE:	09/08/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jean-Pierre Delagneau, administrator		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff member inappropriately handled resident causing bruising.

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 gathering additional evidence in the investigation of the allegation listed aboved. LPA was greeted and granted entry by caregiving staff after stating the purpose of the visit. Administrator Jean-Pierre Delagneau was notified of the visit via telephone and arriver later to assist with the visit.

During the visit, LPA conducted or attempted interviews with all four residents currently in care at the facility.

The findings delivered previously on August 22, 2023 remain unchanged at this time. An exit interview was conducted and a copy of this report was provided to a facility representative.

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: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

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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