306003648-10-12-2022-22-AS-MSTC-CLP8FV-20221130212921

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003648
Report Date: 10/12/2022
Date Signed: 10/12/2022 01:52:49 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
03/11/2021 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210311161741

FACILITY NAME:	ABRAHAM HOUSE		FACILITY NUMBER:	306003648
ADMINISTRATOR:	JIM MORGAN		FACILITY TYPE:	735
ADDRESS:	558 MAPLEWOOD STREET, N.		TELEPHONE:	(714) 923-1230
CITY:	ORANGE	STATE: CA	ZIP CODE:	92867
CAPACITY:	5	CENSUS: 3	DATE:	10/12/2022
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Gilbert Marquez		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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-The facility did not have an emergency plan in the premises.

-Facility is not adequately staffed to meet clients needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegations. LPA arrive at facility was greeted at the door by staff and granted entry. LPA spoke with Gilbert Marquez, Administrator via video call and explained the purpose of the visit.

Findings are based upon this investigation which included pertinent documents obtained, records review and interviews conducted.
It is alleged that the facility did not have an emergency plan in the premises. LPA Martinez conducted a tele-visit to the facility on 03/18/2021 and observed the emergency and disaster plan, three sketches of the emergency exits, and emergency phone numbers posted on the bulletin board in the facility located between kitchen and dining room. Per records review a copy of the safety checks conducted for the facility was obtained.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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-20210311161741

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: ABRAHAM HOUSE	FACILITY NUMBER: 306003648
	VISIT DATE: 10/12/2022

NARRATIVE

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Interviews with staff revealed that facility conducts emergency drills at the facility for clients to prepared them in the case of an emergency. Fire drill test and evacuation drills are conducted twice a year with clients and staff participating. Along with the fire drill facility staff conduct a safety check for all smoke detectors, fire panels and fire extinguishers. Drills are conducted in the beginning of the year and the end of the year. LIC624 received on 02/06/2021 indicates that facility incident happened at 6:45pm and the entire house was evacuated.

It is alleged that facility is not adequately staffed to meet the clients needs. Per regulation 85065.5 Day staff-client ratio indicates (a) Whenever a client who relies upon others to perform all activities of daily living is present, the following minimum staffing requirements shall be met: (1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center but no less than one direct care staff to three such clients. (2) For all other clients, there shall be a staff-client ratio of no less than one direct care staff to three such clients. Per regulation 85065.6(g) Night Supervision indicates (g) In facilities providing care to Regional Center clients who rely upon others to perform all activities of daily living, night supervision shall be maintained as required by the Regional Center, but no less than the staff-client ratio specified in Sections 85065.6(f) and (f)(1). Records review indicated that facility schedule reflects there is 2-3 care staff at any given shift through the 24 hour period. At the time of incident, the facility census was 4 clients. There were two care staff and the Administrator present at the facility at the time of the incident. Per interviews with staff revealed that facility Administrator generates care staff schedule to always have anywhere from 2-3 staff at all times in any given shift.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegations are deemed Unsubstantiated.

An exit interview was conducted with Administrator and a copy of this LIC9099 report was left at facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC9099 (FAS) - (06/04)

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