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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003842
Report Date: 10/02/2023
Date Signed: 10/02/2023 02:45:47 PM

Unsubstantiated


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
06/22/2023 and conducted by Evaluator Kimberly Lyman
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230622155545
FACILITY NAME:GILBERT CARE HOME-MILANFACILITY NUMBER:
306003842
ADMINISTRATOR:ROSANNA MAGKAWASFACILITY TYPE:
735
ADDRESS:322 N. MILAN PLACETELEPHONE:
(714) 484-1880
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:6CENSUS: 5DATE:
10/02/2023
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Arnold AndalTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Facility staff not providing an adequate amount of meals to a resident in care
Facility staff spoke to resident in an inappropriate manner
Facility staff does not ensure that resident is in bed at a reasonable time
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility, interviewed staff as well as reviewed and obtained pertinent documentation such as Individual Program Plan (IPP) and facility notes. Regarding the allegations that facility staff not providing an adequate amount of meals to a resident in care, facility staff spoke to resident in an inappropriate manner and facility staff does not ensure that resident is in bed at a reasonable time, the investigation revealed the following: Facility documents meals consumed and facility documentation indicated Client 1 (C1) is consuming three meals a day as well as a snack. Documents detail what was consumed as well. Six out of six staff deny withholding any meals from the client. LPA observed an ample food supply. Six out of six staff deny any inappropriate conversation with C1 or any clients. Witness indicates not hearing any inappropriate conversation but hearing about the conversations second hand. Three out of three staff knowledgeable CONTINUED ON LIC 9099C DATED 10/02/2023
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
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 2
Control Number 22-AS-20230622155545
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: GILBERT CARE HOME-MILAN
FACILITY NUMBER: 306003842
VISIT DATE: 10/02/2023
NARRATIVE
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about bed times indicate C1 prefers to stay up late playing on the IPAD and will refuse to go to bed at earlier times. LPA is unable to interview C1. Per IPP dated 11/29/2022 and Individual Service Plan dated 04/19/2023, C1 is diagnosed with Mild Intellectual Disability and Cerebral Palsy with a history of false accusations. C1's behavioral objectives are to reduce the frequency of false accusations from 25.83 times per month to 4 times per month. Due to conflicting information, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2