306002817-8-22-2023-22-AS-MSTC-CW659M-20230929194541

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002817
Report Date: 08/22/2023
Date Signed: 08/22/2023 10:32:08 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:	08/22/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jean-Pierre Delagneau, Administrator		TIME COMPLETED:	10:45 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 delivering findings into the investigation of the allegation listed above. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit. Administrator Jean-Pierre Delagneau was present at the time of the visit..

An initial complaint investigation visit was conducted by the Department on April 25, 2022. Two staff interviews were conducted. Resident records for resident R1 were also requested and obtained during the visit. A follow-up visit was conducted on August 4, 2023 along with two additional witness interviews.

Resident R1 was admitted to the facility on March 9, 2022 with additional hospice care provided by Compassus Hospice at the time of the admission. Witnesses and staff confirm that the period of admission was made complicated by the resident's anxiety and related behavior described.
CONTINUED ON 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: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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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Control Number 22-AS-20220421143322

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: GLORIOUS HOME #2	FACILITY NUMBER: 306002817
	VISIT DATE: 08/22/2023

NARRATIVE

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CONTINUED FROM LIC9099
Shortly after admission, resident R1 gave her notice to facility administrator, indicating that the final day at the facility would be April 15, 2023. On April 12, 2023, R1 anticipated on their move-out date and left the facility to return home earlier than initially planned. Two interviews with witnesses who were frequently present at the facility and involved with the resident confirmed that the period of admission was very complicated and describe resident R1 as being difficult and having a tough time adapting to life in the community.

Regarding the allegation that Staff member inappropriately handled resident causing bruising, the following has been concluded: Based on interviews with staff and witnesses, none of the evidence gathered corroborates the allegation of inappropriate handling, intentionally or otherwise. Despite the difficult adjustment and hasty discharge from the facility, resident R1 appeared to remain on good terms with facility staff and residents, for example voluntarily visiting a few weeks after returning home. As a result, the allegation is found to be Unsubtantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC9099 (FAS) - (06/04)

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