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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003933
Report Date: 07/26/2023
Date Signed: 07/26/2023 10:51:06 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
05/11/2023 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230511153559

FACILITY NAME:CHATEAU ST. MARK HOMES 1FACILITY NUMBER:
306003933
ADMINISTRATOR:ANICIA LOPEZFACILITY TYPE:
735
ADDRESS:9671 RANDOM DRIVETELEPHONE:
(714) 635-7732
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 0DATE:
07/26/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Julie Hilahan-CaregiverTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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The facility is not being kept clean and sanitary.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. and Licensing Program Manager (LPM) Alisa Ortiz conducted an unannounced complaint visit to deliver findings on the above allegation received on 05/11/23. LPA and LPM were greeted and granted entry into the facility and met with Caregiver Julie Hilahan and explained the reason for the visit. Administrator (AD) Martin Lopez was notified via telephone.

This agency has investigated the complaint alleging that facility is not being kept clean and sanitary. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Three of seven individuals interviewed confirmed the allegation. Three of seven individuals denied the allegation and the remaining individual could not be qualified to answer questions. Per interviews conducted Client 1 (C1) reported that his bedding gets changed twice per month or less and/or that his room does not get clean very often. During the initial visit on 05/19/23 LPA tour the facility and observed that the ventilator cover in the hallway was bent, rusted, had chipped paint, dust, and
CONTINUED ON LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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 5
Control Number 22-AS-20230511153559
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CHATEAU ST. MARK HOMES 1
FACILITY NUMBER: 306003933
VISIT DATE: 07/26/2023
NARRATIVE
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had mold on the base. In the entrance to the kitchen LPA observed brown and black discoloration on the floor and bases of the door and wall. LPA also observed that the top of the kitchen refrigerator was covered with dust and the wall adjacent to it had brown and black discoloration and dust. On the right-side entrance to the kitchen LPA observed a cabinet with chipped paint, a ripped plastic cover and brown and black discoloration. Additionally, LPA observed that the cabinet above the stove had brown and black grease stains. The stove ventilation above the cabinet had brown and black discoloration and was covered withs dust and grease.

Based on LPA's observation and information gathered during the investigation, the preponderance of evidence standard has been met, therefore the following allegation: the facility is not being kept clean and sanitary is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D.



An exit interview was conducted with caregiver Hilahan Lopez and a copy of this report and the Appeal Rights were provided at the time of this visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20230511153559
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CHATEAU ST. MARK HOMES 1
FACILITY NUMBER: 306003933
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2023
Section Cited
CCR
80087(a)
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80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidence by LPA observed that the hallway ventilator, refrigerator, kitchen cabinet, and kitchen
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Licensee to provide pictures of remodel facility kitchen and hallway ventilator by POC due date.
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floor and bases were rusted, had chipped paint, dust, mold and/or had black and brown discoloration.
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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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5