306003953-5-9-2023-22-AS-SSAS-CRPNSX-20230510104351

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003953
Report Date: 05/09/2023
Date Signed: 05/09/2023 12:40:45 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
02/06/2023 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230206155919

FACILITY NAME:	NOHL RANCH ELDERLY CARE III		FACILITY NUMBER:	306003953
ADMINISTRATOR:	GABE/MARIANA CORCHES		FACILITY TYPE:	740
ADDRESS:	2128 E. WHITE LANTERN LANE		TELEPHONE:	(714) 282-8807
CITY:	ORANGE	STATE: CA	ZIP CODE:	92867
CAPACITY:	6	CENSUS: 5	DATE:	05/09/2023
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Mariana Corches - Licensee/Administrator		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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5
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9

Resident claimed staff touched her inappropriately.

INVESTIGATION FINDINGS:

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3
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5
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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to conduct subsequent interviews that could not be completed during the original visit February 8, 2023. LPA Haley identified himself and explained the reason for the visit with staff.

During the visit LPA Haley interview Resident 3 (R3) and Resident 5 (R5). LPA Haley was emaild copies of R5's medical documentation. Documentation for R3 was provided after the initial visit in February.

After both interviews were conducted, it was determined the complaint will remain unsubstantiated. Complaint findings delivered May 4, 2023 will not be changed.

An exit interview was conducted, and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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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