306003744-11-10-2021-22-AS-MVAO-CBGTU8-20220209140154

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003744
Report Date: 11/09/2021
Date Signed: 11/10/2021 02:47:47 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
03/22/2021 and conducted by Evaluator Lydia Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210322141503

FACILITY NAME:	QUALITY CARE PLUS		FACILITY NUMBER:	306003744
ADMINISTRATOR:	MARJAN ARASTOO		FACILITY TYPE:	735
ADDRESS:	1652 W. BROADWAY		TELEPHONE:	(714) 635-6561
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92802
CAPACITY:	80	CENSUS: 75	DATE:	11/09/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Marjan Arastoo		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility is understaffed

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Lydia Martinez made an unannounced visit to this facility to deliver findings on above allegation. LPA Martinez met with Administrator (AD) Marjan Arastoo and discussed the purpose of the visit.

During the course of the investigation, LPA Martinez toured the facility, interviewed staff and witnesses, as well as reviewed and obtained copies of pertinent documentation such as Personnel Reports (LIC500) for the months of 01/2021, 02/2021 and 03/2021, Client roster and employment Advertisements for Caregiver. Regarding the allegation that facility is understaffed, the investigation revealed the following:

On 03/25/2021, AD Marjan admitted to working the mornings as Caregiver/MedTech, has only 1 Housekeeper, 1 Kitchen staff for the 75 clients; 1 MedTech who works the evening shift, has no Housekeeper on the afternoons/evening or weekends, and there is no Activity Director. AD stated there is 1 Caregiver/Supervisor in the evenings and 1 Night Supervisor.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

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-20210322141503

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: 11/09/2021

NARRATIVE

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On 09/03/2021, AD admitted to only having the following staff: AD works as Caregiver/MedTech, has 1 MedTech/Caregiver, 1 Housekeeper, and 1 Kitchen staff for the 74 clients. AD also admitted to having no Activity Director, therefore there are no activities scheduled and stated Abdol Arastoo helps at the facility as her On-call/Assistant.

On 11/02/2021 and 11/04/2021, LPA observed, and AD admitted being the only Caregiver/MedTech for the 75 clients. She stated she hired an Activity Director who left out of town days after starting and she does not believe he is returning. As of 11/02/2021 there is no Cook and Assistant Administrator Abdol Arastoo was observed making lunch for the clients. AD Marjan stated her Assistant Abdol is making the meals with her help until they can hire a new Cook. There are 2 House Keepers who work Monday thru Friday. There are no Housekeepers on weekends. There is 1 MedTech and 1 Night Supervisor according to interviews with several residents. AD Marjan and Adbol stated they have tried to hire staff but have had no luck.

Facility is in disrepair. Client rooms are dirty, beds are physically falling apart with dirty linens. Clients are smoking in their room (LPA’s observed on 11/02/2021). Call system is non-operational, Common restrooms have no toilet paper, paper towels and no hand soap. Client files are disorganized.

Based on the investigation, the preponderance of evidence standard has been met, therefore allegation that the facility is understaffed is found to be Substantiated. Violation is being cited per California Code of Regulations, (Title 22, Division 6, Chapter 8), on the attached LIC 9099D.

An exit interview was conducted with AD Marjan, copy of this report and Appeal Rights will be emailed.

SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20210322141503

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: 11/09/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/12/2021 Section Cited CCR 80078(a)	1 2 3 4 5 6 7	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:	1 2 3 4 5 6 7	AD to assure adequate staffing is maintained at all times to always provide care, supervision and services of the individuals that reside at this facility are being met.
	8 9 10 11 12 13 14	Facility lacks adequate staffing. AD is only MedTech/Caregiver Monday thru Thursday for the 76 clients. There is no Cook, no Activity Director and No Housekeepers on the evenings and weekends. This is an immediate threat to all the Clients in care.	8 9 10 11 12 13 14	This is a second violation in 12 months. An immediate Civil Penalty is assessed today.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

LIC9099 (FAS) - (06/04)

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