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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002986
Report Date: 01/26/2023
Date Signed: 01/26/2023 09:24:01 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/22/2021 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20210122150335
FACILITY NAME:GILBERT CARE HOME-MARKEVFACILITY NUMBER:
306002986
ADMINISTRATOR:NOEL/ARLYN VILLEGASFACILITY TYPE:
735
ADDRESS:1430 S MARKEV STREETTELEPHONE:
(714) 995-1542
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 4DATE:
01/26/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Wilfredo MendozaTIME COMPLETED:
09:15 AM
ALLEGATION(S):
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Facility did not immediately call 911
Facility failed to report client weight loss
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry and explained the reason for the visit.

During the course of the investigation, LPA toured the facility, interviewed staff and witness as well as reviewed and obtained pertinent documentation such as Individual Program Plan (IPP) and weight record. Regarding the allegations that facility failed to report client weight loss and facility did not immediately call 911, the investigation revealed the following: Six out of seven witnesses interviewed confirm facility is in communication with Client 1's (C1) responsible party regarding weight fluctuations and everything else concerning the client's health status. Licensee and staff that accompanies C1 to medical appointments confirm Neurologist is updated monthly regarding weight fluctuations. Facility staff indicate facility is following neurologist's recommendations regarding response to C1's seizures. Five out of six witnesses interviewed state facility is following the neurologist's protocol. The protocol is to call 911 when a seizure lasts over 5 minutes. Smaller seizures are dealt with at the facility. CONTINUED ON LIC 9099C DATED 01/26/2022.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
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 3
Control Number 22-AS-20210122150335
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: GILBERT CARE HOME-MARKEV
FACILITY NUMBER: 306002986
VISIT DATE: 01/26/2023
NARRATIVE
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Facility provided training to LPA indicating same protocol. C1's IPP dated 05/28/2020 indicates 911 is to be called with "Any prolonged seizure." Facility did not provide documentation of seizure times to LPA but stated if 911 was not called, they were under 5 minutes. Per facility documentation, C1 was sent out for seizures and fall via ambulance on 01/10/2021 and remained hospitalized until 01/16/2021. Due to conflicting information, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3