306003595-3-19-2024-22-AS-AORZ-D3TNWD-20240329104921

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003595
Report Date: 03/19/2024
Date Signed: 03/19/2024 12:13:42 PM

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
09/05/2023 and conducted by Evaluator Andrea Mendivil

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230905151305

FACILITY NAME:	DANBERRY RESIDENTIAL CARE		FACILITY NUMBER:	306003595
ADMINISTRATOR:	ROD INACAY		FACILITY TYPE:	740
ADDRESS:	14611 DANBERRY CIRCLE		TELEPHONE:	(714) 731-7826
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	6	CENSUS:	DATE:	03/19/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:			TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff handled resident in a rough manner
Staff made inappropriate comments to resident
Staff did not take resident to medical appointments
Staff did not allow resident to leave room
Staff did not provide residents with activities
Staff yelled at resident.

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by Richard Sumbillo, Caregiver and explained the reason for the visit.

The department received a complaint on 09/05/2023 and LPA Mendivil conducted her initial visit on 09/12/2023. During the course of the investigation LPA Mendivil obtained pertinent documents such as: physician reports, admission agreements and staff training documents. Regarding the allegations Staff handled resident in a rough manner, Staff made inappropriate comments to resident, Staff did not take resident to medical appointments, Staff did not allow resident to leave room, Staff did not provide residents with activities and Staff yelled at resident, the investigation revealed the following:
Based on interviews with 3 out of 3 residents stated that staff has not handed them in a rough manner, staff has not yelled at them or made inappropriate comments.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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-20230905151305

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: DANBERRY RESIDENTIAL CARE	FACILITY NUMBER: 306003595
	VISIT DATE: 03/19/2024

NARRATIVE

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Interviews with 2 out of 2 staff reported they have not handled residents in a rough manner, have not yelled at residents or made inappropriate comments. Per review of staff files all staff have current personal rights training from May 2023.

Per review of admission agreement the facility has outlined that they can provide ride service if resident’s responsible party is unavailable at a charge of $50 and they require at least 48 hour notice for transportation. Based on an interview with Licensee Rod Incay the request for transportation was requested within 24 hours and he could not accommodate.

Based on interviews with 2 out of 2 staff deny not allowing residents to leave their room. Per Licensee Rod, all residents are told to be mindful of their roommates. Licensee Rod stated that all 3 residents have different needs and likes when it comes to activities and the facility has provided activities such as walking, board games, and cards.

Therefore based on the preponderance of evidence through records reviewed and interviews, the allegations Staff handled resident in a rough manner, Staff made inappropriate comments to resident, Staff did not take resident to medical appointments, Staff did not allow resident to leave room, Staff did not provide residents with activities and Staff yelled at resident are determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. This agency has investigated this complaint.

No deficiencies cited.

An exit interview was conducted and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

LIC9099 (FAS) - (06/04)

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