306003774-9-21-2022-22-AS-AORZ-CJPNM5-20220928103432

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003774
Report Date: 09/20/2022
Date Signed: 09/21/2022 10:56:46 AM

Unfounded

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
02/07/2022 and conducted by Evaluator Kathrina Chin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220207084545

FACILITY NAME:	JUST LIKE HOME, III		FACILITY NUMBER:	306003774
ADMINISTRATOR:	ROBERT MASSUCO		FACILITY TYPE:	740
ADDRESS:	782 S. FAIRMONT WAY		TELEPHONE:	(714) 602-6231
CITY:	ORANGE	STATE: CA	ZIP CODE:	92869
CAPACITY:	6	CENSUS: 5	DATE:	09/20/2022
		UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Roda Paderna, Administrator		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff member made an inappropriate comment to resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathrina Chin conducted an unannounced visit for the purpose of delivering the findings on a complaint investigation. LPA met with Fernando Yusi, caregiver and was granted entry. LPA Chin spoke with Roda Paderna, Administrator on the telephone.

The investigation into the allegation that staff member made an inappropriate comment to resident in care revealed the following:

LPA interviewed R1 who stated that she was confused at the time and denied that a staff member made an inappropriate comment. R1 stated that two caregivers are both very nice and helpful to her. LPA also interviewed R2 and R3 and both indicated that staff are nice and patient. (Continued on LIC 9099C)

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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-20220207084545

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: JUST LIKE HOME, III	FACILITY NUMBER: 306003774
	VISIT DATE: 09/20/2022

NARRATIVE

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Staff 1 and Staff 2 denied that they made inappropriate comments to R1.

Based on the above findings, this allegation is determined to be UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted and appeal rights explained with Roda Paderna over the telephone. A copy of this report was given to Fernando Yusi, caregiver.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina Chin	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC9099 (FAS) - (06/04)

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