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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003744
Report Date: 01/05/2023
Date Signed: 01/05/2023 04:44:32 PM

Document Has Been Signed on 01/05/2023 04:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
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: 65DATE:
01/05/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:01 PM
MET WITH:Marjan Arastoo, AdministratorTIME COMPLETED:
05:00 PM
NARRATIVE
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting a case management inspection. LPA met with administrator Marjan Arastoo and explained the purpose of the visit.

An alleged theft is reported to have occurred on December 25, 2022 in the room shared by clients C1 and C2. Based on a review of clients records maintained at the facility, no internal documentation of the incident appears to have been made. No report of the incident was made to the Department in the appropriate time period either.

LPA conducted interviews with two staff members present along with the administrator. Interviews evidenced potentially disruptive behavior displayed by one client with possible implications for the health, safety and personal rights of other individuals in care.

Based on the review of records conducted at the facility, one deficiency is being cited under Title 22 Division 6 of the California Code of Regulations. A Technical Advisory is also issued to the facility in regards to clients' Personal Rights. An exit interview was conducted and a copy of this report along with appeal rights was provided and left at facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/05/2023 04:44 PM - It Cannot Be Edited


Created By: Kevin Saborit-Guasch On 01/05/2023 at 03:27 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: QUALITY CARE PLUS
FACILITY NUMBER: 306003744

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/25/2023
Section Cited
CCR
80061(a)(1)(E)

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The California Code of Regulations Sectiion 80061(a)(1)(E) on Reporting Requirements indicates that: "(a) Each licensee or applicant shall furnish to the licensing agency reports (...), including (...) (E) Any unusual incident or client absence which threatens the physical or emotional health or safety of any client."
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Licensee and administrator will review the cited regulations and ensure that an adequate reporting process is in place for any future incidents.
The initial incident will additionally be reported to the Department before the plan of corrections due date.
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This requirement is not met as evidenced by the fact that the licensee did not report an event of theft that is alleged to have occurred on 12/25/2022. This failure to report poses a potential risk to the health and safety of the persons in charge.
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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.
SUPERVISOR'S NAME:Sheila Santos
LICENSING EVALUATOR NAME:Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2023


LIC809 (FAS) - (06/04)
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