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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003887
Report Date: 05/19/2021
Date Signed: 05/19/2021 12:56:01 PM



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
10/06/2020 and conducted by Evaluator Albert Marin
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20201006082346
FACILITY NAME:ARIES HOME CAREFACILITY NUMBER:
306003887
ADMINISTRATOR:EVANGELINE SALAZARFACILITY TYPE:
740
ADDRESS:9061 ORANGEWOOD AVENUETELEPHONE:
(714) 530-7522
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:6CENSUS: 5DATE:
05/19/2021
UNANNOUNCEDTIME BEGAN:
11:23 AM
MET WITH:Administrator Nida Granville TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Staff are not properly trained.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to deliver the complaint findings for the complaint filed against this facility. LPA met with Administrator (AD) Nida Granville and stated the purpose of this visit.

On October 6, 2020 The Department received a complaint with allegation that staff are not properly trained. Based on observation, interviews and file review, AD Granville has a valid Administrator’s certificate until December 12, 2021. Staff 1 (S1) started working in the facility in January 2020. Staff 1 (S1) has a valid first aid certificate until December 2021 and completed a total of 10 out of 40 required hours for initial training. Staff 2 (S2) started working in October 10, 2020; has a valid first aid and cardiopulmonary resuscitation training until October 15, 2022; and completed a total of 5 out of 40 required hours for initial training. The preponderance of the evidence standard has been met. Therefore, the allegation that staff are not properly trained is substantiated.
(Page 1/7)

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
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 7
Control Number 22-AS-20201006082346
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: ARIES HOME CARE
FACILITY NUMBER: 306003887
VISIT DATE: 05/19/2021
NARRATIVE
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During the investigation, deficiencies were observed; and citations were issued per Title 22 Division 6 of the California Code of Regulations.

LPA Marin conducted an exit interview with AD Granville. LPA discussed the deficiencies, citations, and appeal rights. Copies of this report, deficiency page, appeal rights and cited regulations were left in the facility.

(Page 2/7)
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 22-AS-20201006082346
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: ARIES HOME CARE
FACILITY NUMBER: 306003887
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/19/2021
Section Cited
HSC
1569.625(b)(1)
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§1569.625 Staff training; legislative findings; contents... This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care...and four hours specific to postural supports, restricted health conditions, and hospice care... This requirement was not met as evidenced by:
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Since this facility is under new ownership from 11/25/2020, as plan of correction, the citation will be cleared but a technical advisory will be issued to the new facility - Morning Sunrise Villa. The Administrator agreed to ensure that staff members meet the required amount for initial training.
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Based on file observation, file review and interviews, the facility did not meet the required 40 hours of initial training for Staff 1 and Staff 2. This posed a potential threat on care, supervision, health and safety of the residents in care.
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Deficiency cleared.
Type B
05/19/2021
Section Cited
HSC
1569.69(a)(2)
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1569.69 Employees assisting residents with self-administration of medication; training requirements...the employee shall complete 10 hours of initial training...6 hours of hands-on shadowing training, ... and 4 hours of other training ...shall be completed within the first two weeks of employment. This requirement was the met as evidenced by:
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Since this facility is under new ownership from 11/25/2020, as plan of correction, the citation will be cleared but a technical advisory will be issued to the new facility - Morning Sunrise Villa. The Administrator agreed to ensure that staff members meet the required amount for initial training on medication.
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Based on file observation, file review and interviews, the facility did not meet the required 10 hours of initial training. Staff 1 had 4 hours of training on medication on file. Staff 2 had no training on medication on file. This posed a potential threat on care, supervision, health and safety of the residents in care.
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Deficiency cleared.
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: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 7
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
10/06/2020 and conducted by Evaluator Albert Marin
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20201006082346

FACILITY NAME:ARIES HOME CAREFACILITY NUMBER:
306003887
ADMINISTRATOR:EVANGELINE SALAZARFACILITY TYPE:
740
ADDRESS:9061 ORANGEWOOD AVENUETELEPHONE:
(714) 530-7522
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:6CENSUS: 5DATE:
05/19/2021
UNANNOUNCEDTIME BEGAN:
11:23 AM
MET WITH:Administrator Nida Granville TIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents are not being changed timely.
Staff do not answer phones.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to deliver the complaint findings for the complaint filed against this facility. LPA met with Administrator (AD) Nida Granville and stated the purpose of this visit.

On October 6, 2020 The Department received a complaint with several allegations. The first allegation was residents are not being changed timely. Four out of five witnesses interviewed stated that residents received appropriate attention and care. During the in person visit in the facility, LPA Marin observed that the residents in care were appropriately dressed in clean clothes; resident’s rooms appeared clean and in order; and free of any offending odors. Per interviews, there was no concern on the cleanliness of the facility or issues with neglect with resident needing incontinent care.

(Page 4/7)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 22-AS-20201006082346
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: ARIES HOME CARE
FACILITY NUMBER: 306003887
VISIT DATE: 05/19/2021
NARRATIVE
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The next allegation was staff do not answer phones. Based on observation, LPA James August observed the facility landline was in working condition during the initial investigation visit done on October 9, 2020. On several occasions during the investigation, LPA Marin observed that the facility landline was working and did not experience any delay from staff answering the phone. AD Granville provides her mobile number as alternate contact information. Per interview, one witness stated that they had no issues contacting the facility.

Based on the information gathered during the investigation which involved interviews and review of all documents obtained, The Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred. Thus, the allegations that residents are not being changed timely, and that staff do not answer phones are deemed UNSUBSTANTIATED.

LPA Marin conducted an exit interview with AD Granville and copy of this report was left in the facility.

(Page 5/7)
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
10/06/2020 and conducted by Evaluator Albert Marin
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20201006082346

FACILITY NAME:ARIES HOME CAREFACILITY NUMBER:
306003887
ADMINISTRATOR:EVANGELINE SALAZARFACILITY TYPE:
740
ADDRESS:9061 ORANGEWOOD AVENUETELEPHONE:
(714) 530-7522
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:6CENSUS: 5DATE:
05/19/2021
UNANNOUNCEDTIME BEGAN:
11:23 AM
MET WITH:Administrator Nida Granville TIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Administrator is not at the facility for the required hours.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to deliver the complaint findings for the complaint filed against this facility. LPA met with Administrator (AD) Nida Granville and stated the purpose of this visit.

On October 6, 2020 The Department received a complaint with allegation that the administrator is not at the facility for the required hours. Based on observation and interviews, AD Granville is a live-in staff and have been functioning as Administrator since July 2020. She has a valid Administrator’s Certificate from December 13, 2019 to December 12, 2021. On multiple occasions, LPA Marin made phone calls to the facility using the landline, and AD Granville always answered the phone. Administrators Evangeline and Ferdinand Salazar have valid certificate until August 2, 2021. One witness stated that their company had good communication with the facility. Per file review, on the facility schedule for October 2020, AD Granville worked 10 hours per day Monday to Thursday; and 8 hours on Friday. AD Ferdinand Salazar worked 10 hours on Saturday and Sunday.
(Page 6/7)
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 22-AS-20201006082346
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: ARIES HOME CARE
FACILITY NUMBER: 306003887
VISIT DATE: 05/19/2021
NARRATIVE
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This agency has investigated the complaint alleging that the administrator is not at the facility for the required hours. 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 allegation.

LPA Marin conducted an exit interview with AD Granville and copy of this report was left in the facility.

(Page 7/7)
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
LIC9099 (FAS) - (06/04)
Page: 7 of 7