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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002874
Report Date: 05/24/2023
Date Signed: 05/24/2023 10:13:37 AM

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
04/25/2023 and conducted by Evaluator Alvaro Ramirez Jr.
COMPLAINT CONTROL NUMBER: 22-AS-20230425140051
FACILITY NAME:WESTWOOD FAMILY HOMEFACILITY NUMBER:
306002874
ADMINISTRATOR:MANSUETO T. CONANAN, JR.FACILITY TYPE:
735
ADDRESS:910 N. WESTWOOD AVENUETELEPHONE:
(714) 973-0755
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY:6CENSUS: 4DATE:
05/24/2023
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Ella Alcantara-Caregiver, Mansueto Conanan-AdministratorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility failed to follow their own facility sign out procedures
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on 04/25/23. LPA was greeted and granted entry into the facility and initially met with caregiver Ella Alcantara. LPA explained the reason for the visit. Administrator (AD) Mansueto Conanan arrived shortly after.

This agency has investigated the complaint alleging that facility failed to follow their own facility sign out procedures. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: During the investigation LPA reviewed documents including Westwood Family Home House Rules which are the same under the Plan of Operation approved by the Department. Per House Rule number two “A Sign-in/Sign-out form is available for all consumers and visitors to fill up before leaving and when you have returned.” During the course of the interviews AD stated that facility only has a sign in and out sheet for two clients who are independent.
Continued on LIC812C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
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 5
Control Number 22-AS-20230425140051
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: WESTWOOD FAMILY HOME
FACILITY NUMBER: 306002874
VISIT DATE: 05/24/2023
NARRATIVE
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During the initial visit conducted on 04/27/23 and visit conducted on 05/24/23 LPA Ramirez observed that facility only uses a sign in/out sheet for two of four clients in care. Per AD Client 1 (C1) does not have a sign in and out sheet because C1 only goes out with the caregivers and other clients as a group. Four of seven individuals interviewed confirm the allegation.

Based on LPA's observation and information gathered during the investigation, the preponderance of evidence standard has been met, therefore the following allegation: facility failed to follow their own facility sign out procedures is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D.



An exit interview was conducted with AD Conanan and a copy of this report and the Appeal Rights were provided at the time of this visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20230425140051
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: WESTWOOD FAMILY HOME
FACILITY NUMBER: 306002874
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2023
Section Cited
CCR
80022(k)
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80022 Plan of Operation (k) The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so.
This requirement is not met as evidence by: During the initial visit conducted on 04/27/23 and visit conducted on 05/24/23
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Licensee to review their Sign-in/Sign-out House Rule number two and to add a Sign-in/Sign-out sheet for all clients in care. Licensee to email LPA proof by POC due date.
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LPA Ramirez observed that facility only uses a sign in/out sheet for two of four clients in care.
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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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5