306003560-11-17-2023-22-AS-AORZ-CY2NSS-20231129094336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003560
Report Date: 11/17/2023
Date Signed: 11/17/2023 02:23:21 PM

Unfounded

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
11/16/2023 and conducted by Evaluator Jerome Haley

COMPLAINT CONTROL NUMBER: 22-AS-20231116163635

FACILITY NAME:	GRANNY'S PLACE IV		FACILITY NUMBER:	306003560
ADMINISTRATOR:	MALACA, ROCHEL		FACILITY TYPE:	740
ADDRESS:	25665 SABINA AVENUE		TELEPHONE:	(949) 533-5938
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 3	DATE:	11/17/2023
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Rochel Malaca - Administrator Kimberly Walters - Assistant Administrator		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff did not release records to resident's responsible party

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint received November 16, 2023. LPA Haley was greeted by staff and explained the reason for the visit. Administrator (AD) Rochel Malaca was contacted via telephone and arrived a short time later and was present for the reminder of the visit.

Before conducting interviews, LPA Haley toured the interior of the facility with staff.

Regarding the allegation: Staff did not release records to resident's responsible party

During the investigation, interviews were conducted with Administrator Malaca, Owner George Kutnerian, and the Chief of staff for the corporation.

Continued on LIC9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

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-20231116163635

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: GRANNY'S PLACE IV	FACILITY NUMBER: 306003560
	VISIT DATE: 11/17/2023

NARRATIVE

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Administrator Malaca confirmed a request for records was received for Former Resident 1 (FR1), and the records are available for review and photocopying at the companies office in Irvine. The request for records was sent to Owner George Kutnerian via email. Owner Kutnerian confirmed the request was received and the requesting party was called several times, and no email address was provided. During the interview with Owner Kutnerian, he contacted his Chief of Staff via conference call. The Chief of Staff explained he contacted the requesting party several times regarding the request for records. According to the Chief of Staff, the requesting party was contacted Thursday November 16, 2023 at 10:38 AM to discuss a method to provide the records. The Chief of Staff spoke with an employee of the requesting party to work on a method to satisfy the record request and discuss the timeline to provide the records. The employee of the requesting party said they need to check with an attorney regarding a method to provide the records and how much time they have to produce the records. The Chief of Staff never heard back from the requesting party, so additional calls were placed Thursday, November 16, 2023 at 4:16 PM and Friday, November 17 at 11:52AM. Messages for a call back was left with the receptionist after both follow up calls were made to the requesting party.

Based on the information gathered during the investigation through interviews and observation, the allegation mentioned above is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

LIC9099 (FAS) - (06/04)

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