306003953-5-4-2023-22-AS-SSAS-CRPNSY-20230510104351

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003953
Report Date: 05/04/2023
Date Signed: 05/04/2023 11:11:43 AM

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:	05/04/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Mariana Corches		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Resident claimed staff touched her inappropriately.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to deliver the findings on the complaint allegation above. LPA Haley identified himself and explained the reason for the visit with staff.

Regarding the allegation, “Resident claimed staff touched her inappropriately.” The investigation revealed the following:

LPA Haley made the initial unannounced complaint visit February 8, 2023. During the visit, LPA Haley interviewed facility Licensee/Administrator (AD) Mariana Corches, and 2 of 4 facility residents. 2 residents were sleep during the visit and could not be interviewed. Following the initial visit, LPA Haley interviewed a facility staff member, a former facility resident, and six additional individuals.

During the investigation a total of 11 interviews were conducted. 10 of 11 interviews were used to make a determination on the complaint allegation, and 1 interview was used for informational purposes only.

Continued on LIC9099C

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: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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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Control Number 22-AS-20230206155919

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: NOHL RANCH ELDERLY CARE III	FACILITY NUMBER: 306003953
	VISIT DATE: 05/04/2023

NARRATIVE

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2 of 11 individuals interviewed believe/support the complaint allegation based on hearsay, 3 of 11 individuals denied the complaint allegation, and 5 of 11 individuals provided information that was incompatible with the complaint allegation. 1 of 11 individuals interviewed did not provide information that would support or deny the complaint allegation.

LPA Haley was provided evidence that would support the complaint allegation; however, the evidence requested could not change the outcome of the complaint findings.

Based on the information gathered during the investigation, document review and interviews, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

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

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC9099 (FAS) - (06/04)

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