306003734-12-12-2024-22-AS-LMOA-DCH43T-20241231174515

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003734
Report Date: 12/12/2024
Date Signed: 12/12/2024 11:34:42 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
12/06/2024 and conducted by Evaluator Jenifer Tirre

COMPLAINT CONTROL NUMBER: 22-AS-20241206095919

FACILITY NAME:	JAIRE HOME I		FACILITY NUMBER:	306003734
ADMINISTRATOR:	LOUISE IGISAIAR		FACILITY TYPE:	735
ADDRESS:	800 LA REINA STREET, N.		TELEPHONE:	(714) 995-5575
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	6	CENSUS: 6	DATE:	12/12/2024
		UNANNOUNCED	TIME BEGAN:	07:09 AM
MET WITH:	Administrator, Louise Igisaiar		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Facility staff left a client unsupervised while waiting for their therapy session

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced inspection visit to deliver findings for complaint investigation into the above allegations. LPA explained the reason for the visit with Administrator Louise Igisaiar.
During the course of the investigation LPA toured facility, reviewed records, conducted interviews, made visual observations and requested pertinent documentation such as Client Roster, Personnel Report, Individual Program Plan (IPP) and Physician’s reports.
During investigation LPA reviewed facility records such as IPP and Physician's reports for Clients in care. Record review revealed that C1's Individual Program Plan dated June 16, 2024, states that "R1 is driven to all locations by residential and day program staff. R1 is closely accompanied at community based sites." R1's Physician's Report dated March 7, 2024, states that R1 is able to leave facility unassisted. LPA reviewed files of all clients in care and observed based on Physician's Reports three of six clients have marked that they can leave facility unassisted and that three of six clients are not able to leave facility unassisted.
CONTINUED ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

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-20241206095919

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: JAIRE HOME I	FACILITY NUMBER: 306003734
	VISIT DATE: 12/12/2024

NARRATIVE

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Interviews conducted revealed the following: Client 1 (C1) stated that Staff 1 (S1) and Staff 2 (S2) drive and accompany them to medical & therapy appointments. C1 stated that staff always wait for Client to finish sessions. C1 indicated that Staff do not go in to sessions with them unless invited. C1 stated that their mother sometimes picks them up after a session and takes them home. C1 stated that on one recent occasion S1 was not present in therapy waiting area when exited but that C1's mother picked them up that day in therapy parking lot.

Interviews conducted with Staff 1 (S1) revealed that they mainly take C1 to their appointments and sometimes Staff 2 will take C1 as well. S1 stated they wait for Client to finish session. S1 stated that Clients therapy sessions are usually 2 hours long. Staff 1 stated that they wait in small foyer area to therapy office. S1 & S2 both stated that there are limited seating inside small foyer area to therapy office. S1 and S2 stated that they sometimes go to car parked outside office and watch for C1 to exit doors. S1 and S2 communicate with C1 that they are waiting in parking area. S1 stated that on a recent occasion they waited for C1 and seen that C1's mother drove up and parked in parking lot. S1 stated they called C1 on their phone to ask them if their Mother was scheduled to pick them up and C1 stated yes. S1 stated they informed C1 that their mother arrived in parking lot. S1 stated they watched C1 exit therapy building and get into Mother's car and then drove away. Three of Three staff (S1, S2, & S3) interviewed stated that they never leave clients alone during outings. Three of three staff stated that when out in public outings with clients they wait outside restroom areas for Clients. Three of three staff stated that clients do not not need assistance with toileting and keep a watchful eye on clients when out in public.

Based on records reviewed and interviews conducted although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the following allegations: Facility staff left a client unsupervised while waiting for their therapy session is deemed UNSUBSTANTIATED.

An exit interview was conducted with Administrator Louise Igisaiar and a copy of this report was reviewed and provided at the time of this visit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024

LIC9099 (FAS) - (06/04)

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