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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003744
Report Date: 10/01/2021
Date Signed: 10/01/2021 04:14:26 PM

Substantiated


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
08/30/2021 and conducted by Evaluator Lydia Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210830162853
FACILITY NAME:QUALITY CARE PLUSFACILITY NUMBER:
306003744
ADMINISTRATOR:MARJAN ARASTOOFACILITY TYPE:
735
ADDRESS:1652 W. BROADWAYTELEPHONE:
(714) 635-6561
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:80CENSUS: 75DATE:
10/01/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Marjan ArastooTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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* Facility is not providing care and supervision to clients
* Facility is not clean and sanitary
* Facility is not in good repair
* Facility is not maintaining complete client files
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Lydia Martinez for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPA met with Administrator (AD) Marjan Arastoo and explained the reason for today’s inspection.

The investigation into allegations that Facility is not providing care and supervision to clients, Facility is not clean and sanitary, Facility is not in good repair and Facility is not maintaining complete client files revealed the following:

During the course of the investigation, Licensing Program Manager (LPM) Marina Stanic and Licensing Program Analysts (LPA) Lydia Martinez, Norman Woodridge, and Sean Haddad conducted an on-site inspection on 09/03/21, inspected the facility, interviewed clients and staff, and obtained and reviewed copies of facility files.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 8
Control Number 22-AS-20210830162853
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: QUALITY CARE PLUS
FACILITY NUMBER: 306003744
VISIT DATE: 10/01/2021
NARRATIVE
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On 09/03/2021, during the investigation inspection LPA’s and LPM observed and Administrator admitted she only has the following personnel: Administrator works as Caregiver, 1 Med-Tech/Caregiver, and 1 Housekeeper for 74 clients. Administrator also admitted to not having no Activity Director, therefore, there are no scheduled activities. Facility was observed to be in serious disrepair and lacking cleanliness as stated below. Thus, the allegation that the facility is not providing care and supervision to clients is Substantiated.

On 09/03/2021, LPM and LPAs observed the following in the first floor kitchen: grime on the floor, a leaking dishwasher with dirty water dripping into a bowl on the floor, an unused mini fridge with large deposits of black mold and brown material, dirty dining tablecloths, tables excessive amount of clutter in Room 108, dirty wall in Room 105 and Room 109, strong smell of smoke in Room 106, and old dirty mattress in Room 114. On the second floor, LPM and LPAs observed all public restrooms lacked soap, paper towels, and toilet paper, and one public restroom had mold on the shower mat. In multiple client rooms on the second floor, LPM and LPAs observed stains on the floors and carpets, stains on the walls, and stains on the beds. For example, LPM and LPAs observed and/or noted a very strong smell of smoke in Room 202A, crumbs all over the floor in Room 205, stains on the floor and mold/water stains on the ceiling and mattress sitting on bricks and strong smell of marijuana, a stained bed in Room 207, dirty walls and a water leak and rust under the toilet in the bathroom of Room 210, multiple cigarette butts on the dresser in Room 212, dirty mattresses and cigarette ashes on the floor in Room 216, and a dirty air vent in Room 218. Thus, the allegation that the facility is not clean and sanitary is Substantiated.

On 09/03/21, LPM and LPAs observed the following in the first floor kitchen: a large square hole in the ceiling, a leaking dishwasher with dirty water dripping into a bowl on the floor, a broken ice machine, a broken glass window, and, in the adjacent outdoor space, a large outdoor umbrella with the pole broken in half exposing a sharp point; sink is off wall in Room 104, glass is off window frame in Room 111, broken blinds in Room 113. In the stairs to the second floor, the mechanism to hold a door open was not functioning and the door was observed tied open with plastic bags. On the second floor, LPM and LPAs observed exposed wires coming from the ceiling and in multiple rooms beds in disrepair, holes and scratches in the walls and floors, broken closet doors, damaged beds, chairs, and dressers, and lamps missing lamp shades. For example, LPM and LPAs observed a bed in disrepair and a hole in the wall in Room 207, a broken closet door and holes in the floor in Room 202, a dresser in disrepair and a broken closet door in Room 204, and a broken chair and a lamp missing a lamp shade in Room 218. Thus, the allegation that the facility is not in good repair is Substantiated
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 22-AS-20210830162853
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: QUALITY CARE PLUS
FACILITY NUMBER: 306003744
VISIT DATE: 10/01/2021
NARRATIVE
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On today's date, LPA Martinez reviewed 10 of 75 client files. The files were found to be incomplete, unorganized and/or not containing required Licensing forms. Needs and Services Plans were missing and/or Physician Reports were not updated as of 2016 for 5 of the 10 client files. Thus, allegation that facility is not maintaining complete client files is Substantiated.

During the course of the investigation, CCLD obtained sufficient evidence to substantiate the allegations mentioned above. The preponderance of evidence standard has been met; therefore, the above allegations are Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted and a copy of this report along with Appeal Rights will be emailed to AD Arastoo
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 22-AS-20210830162853
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: QUALITY CARE PLUS
FACILITY NUMBER: 306003744
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/05/2021
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by:
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Licensee/Administrator agrees to submit a written plan of action to ensure staff coverage is available at all times. POC to be submitted to LPA by 10/05/2021 along with current LIC500.
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Facility lacks adequate staffing. AD and MedTech are only Caregivers for the 75 clients, which poses a potential health and safety risk to clients in care.
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Type A
10/05/2021
Section Cited
CCR
80087(a)
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Buildings and Grounds (a) The facility shall be clean, safe, sanitary … at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidenced by: Based on observation, the licensee allowed the following conditions at the facility:
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Licensee/Administrator agrees to submit a plan of action by close of business day of 10/05/2021 to CCLD.
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a refrigerator with large deposits of black mold; multiple public restrooms lacking soap, paper towels and toilet paper; a shower mat with heavy mold; multiple residents rooms with dirty air vents; stains on the wall, carpet and beds; and soiled mattresses, which poses a potential health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 22-AS-20210830162853
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: QUALITY CARE PLUS
FACILITY NUMBER: 306003744
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/04/2021
Section Cited
CCR
80087(a)
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(a) The facility shall be … in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidenced by: Based on observation, the licensee allowed the following conditions at the facility:
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Licensee/Administrator agrees to submit a plan of action by close of business day of 10/05/2021 to CCLD.
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a broken glass window in the kitchen, a leaking dishwasher, an outdoor umbrella pole broken in half exposing a sharp point in the yard outside of the kitchen, wires coming from the ceilings, and in multiple rooms beds in disrepair, broken closet doors, and broken furniture, which poses an immediate health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 22-AS-20210830162853
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: QUALITY CARE PLUS
FACILITY NUMBER: 306003744
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/05/2021
Section Cited
CCR
80070(a)
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Client Records: The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client. This regulation was not met as evidenced by: Review of 10 of 75 client files were found to be incomplete, unorganized and/or not containing required forms.
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Licensee/Administrator agrees to submit a plan of action by close of business day of 10/05/2021 to CCLD.
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This poses a potential risk to health and safety to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC9099 (FAS) - (06/04)
Page: 8 of 8