306003735-4-20-2023-22-AS-SSAS-CR7QDF-20230424120438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003735
Report Date: 04/20/2023
Date Signed: 04/20/2023 09:26:02 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
01/09/2023 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230109164743

FACILITY NAME:	JAIRE HOME II		FACILITY NUMBER:	306003735
ADMINISTRATOR:	ANA BIEN DEVERA		FACILITY TYPE:	735
ADDRESS:	1242 ALAMO STREET		TELEPHONE:	(714) 635-3788
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	6	CENSUS: 3	DATE:	04/20/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Emalene Dimagmaliw, Care Staff		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Staff hit client.
Level of care was not met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit to deliver the findings for complaint control number: 22-AS-20230106102148 and into the above allegations. At 8:45am, LPA Cho received verbal consent by Licensee Ariel Resurreccion via a telephone call allowing Care Staff Dima Gmaliw to sign the report. During the course of the investigation, LPA reviewed and obtained copies of records pertinent to Client 1 (C1) and interviews were conducted with the client, staff, and the Administrator. The following was determined:

It was alleged that the staff hit Client 1 (C1) on the face or arm. The Reporting Party (RP) was unable to identify the name of the staff in question and provide the details of the alleged incident. Interviews with seven out of the seven individuals denied the allegation nor have witnessed a staff hitting C1. C1 indicated that she was hit by a staff whose name was not provided and digressed mid-sentence stating that she was hit by a client in lieu of the staff. LPA verified through record review that C1 has a history of making false statements per the Fourth Quarter/Annual Progress Review dated December 11, 2022.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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-20230109164743

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: JAIRE HOME II	FACILITY NUMBER: 306003735
	VISIT DATE: 04/20/2023

NARRATIVE

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Due to the insufficient information and the inconsistent statements made by C1, LPA is unable to corroborate the allegation.

It was alleged that the level of care was not met. It was reported that C1 utilizes the bedside commode and that the facility staff does not promote C1 to use the toilet in the bathroom. Seven out of the seven individuals stated that C1 alternates use between the bathroom and commode and that C1 is encouraged to use the bathroom toilet daily. In addition, seven out of the seven individuals also confirmed that C1 experiences incontinence which is why C1 utilizes a diaper. C1 expressed that she utilizes the commode and the bathroom and indicated that C1 will utilize the commode if necessary.

Therefore, based on the observations, interviews, and the records reviewed, 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 above allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted with Care Staff Emalene Dimagmaliw, and a copy of this report along with the LIC811 were provided during this visit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC9099 (FAS) - (06/04)

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