306003840-9-14-2023-22-AS-AORZ-CW5PSR-20230929113446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003840
Report Date: 09/14/2023
Date Signed: 09/14/2023 04:05:59 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/08/2023 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230908135602

FACILITY NAME:	GRACIOUS CARE HOMES		FACILITY NUMBER:	306003840
ADMINISTRATOR:	DAVID NEHEM/S.MITCHELL		FACILITY TYPE:	740
ADDRESS:	4110 E. JORDAN AVENUE		TELEPHONE:	(714) 289-1946
CITY:	ORANGE	STATE: CA	ZIP CODE:	92869
CAPACITY:	6	CENSUS: 6	DATE:	09/14/2023
		UNANNOUNCED	TIME BEGAN:	01:27 PM
MET WITH:	Joselene Poy Lorenzo-Caregiver		TIME COMPLETED:	04:21 PM

ALLEGATION(S):

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Staff are not providing enough food for the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Caregiver Joselene Poy Lorenzo. LPA explained the reason for the visit. Administrator was notified by caregiver via telephone.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Five of five individuals interviewed denied the allegation. During the interviews with residents it was reported that staff provide enough food and/or that the food is delicious. At 1:34 PM LPA tour the facility and observed that the pantry has unexpired canned food, boxes of cereal, bags of pasta, dried raisins and oatmeal. At 1:36 LPA tour the kitchen and observed the facility to have a two-day perishable and seven-day non-perishable supply of food for six residents in care.

CONTINUED on LIC9099C...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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 4

Control Number 22-AS-20230908135602

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GRACIOUS CARE HOMES	FACILITY NUMBER: 306003840
	VISIT DATE: 09/14/2023

NARRATIVE

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During interviews conducted with staff it was reported that residents get three meals per day and that residents can request a second plate and/or a snack. Per Resident 1 (R1) staff will provide extra food if residents ask for more.

Therefore, the allegation is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

LPA Ramirez conducted an exit interview with caregiver Poy Lorenzo, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/08/2023 and conducted by Evaluator Alvaro Ramirez Jr.

COMPLAINT CONTROL NUMBER: 22-AS-20230908135602

FACILITY NAME:	GRACIOUS CARE HOMES		FACILITY NUMBER:	306003840
ADMINISTRATOR:	DAVID NEHEM/S.MITCHELL		FACILITY TYPE:	740
ADDRESS:	4110 E. JORDAN AVENUE		TELEPHONE:	(714) 289-1946
CITY:	ORANGE	STATE: CA	ZIP CODE:	92869
CAPACITY:	6	CENSUS: 6	DATE:	09/14/2023
		UNANNOUNCED	TIME BEGAN:	01:27 PM
MET WITH:	Joselene Poy Lorenzo-Caregiver		TIME COMPLETED:	04:21 PM

ALLEGATION(S):

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Staff are unable to communicate effectively with the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Caregiver Joselene Poy Lorenzo. LPA explained the reason for the visit. Administrator was notified by caregiver via telephone.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: One of three residents interviewed corroborated the allegation. Two of two staff interviewed denied the allegation. During interviews conducted with staff it was reported that staff can communicate effectively with residents and that staff can assist with the residents' Activities of Daily Living (ADLs). During the course of the interviews Resident 1(R1) stated that the caregivers speak good English and that staff can communicate. During today's visit LPA observed as caregivers had a conversation and/or sang along with a resident watching television in the living room.
CONTINUED LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20230908135602

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GRACIOUS CARE HOMES	FACILITY NUMBER: 306003840
	VISIT DATE: 09/14/2023

NARRATIVE

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Based on LPA's observation and information gathered during the investigation, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with caregiver Poy Lorenzo, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC9099 (FAS) - (06/04)

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