306003971-10-1-2021-22-AS-LADS-C7LPPU-20211008113008

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003971
Report Date: 10/01/2021
Date Signed: 10/01/2021 04:35:47 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
10/23/2020 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201023105347

FACILITY NAME:	NANCITA HOME		FACILITY NUMBER:	306003971
ADMINISTRATOR:	AARON RESURRECCION		FACILITY TYPE:	735
ADDRESS:	713 N. NANCITA STREET		TELEPHONE:	(714) 220-2657
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	6	CENSUS: 5	DATE:	10/01/2021
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Roger Viquiera		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Facility staff aggressive with client.
Facility staff threatened to hit client.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings on the investigation into the allegations listed above. LPA was greeted and granted entry by facility staff. LPA explained the reason for the visit. LPA met with Administrator Clarisse Marcelino via FaceTime and Lead Staff member Roger Viquiera who was present at the facility. The investigation into the allegation, facility staff aggressive with client, revealed the following; Sometime in October 2020 Client 1 (C1) contacted their mother and reported Staff 1 was yelling at them and flailing their arms. 4 of 4 staff members reported they have never witnessed any type of abuse including verbal abuse against any clients and have never witnessed any aggressive acts towards clients or other staff members. None of the clients could corroborate the allegations. The Administrator reported there have been no instances of any shouting or yelling between clients and staff. The facility has not reported to the Agency any unusual or special incidents involving any type of yelling, arguing or altercations between staff and clients or client to client. The Administrator affirmed this. The family members of the clients involved would not return requests for interviews.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021

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-20201023105347

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: NANCITA HOME	FACILITY NUMBER: 306003971
	VISIT DATE: 10/01/2021

NARRATIVE

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Based on the evidence gathered, the allegation, facility staff aggressive with client is deemed to be unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

Regarding the allegation, facility staff threatened to hit client, the investigation revealed the following; It was reported that Staff 1 said, “I want to hit him”, referring to C1. This statement could not be corroborated by any witnesses. 4 out of 4 staff members interviewed reported they have never witnessed any type of abuse including verbal abuse against any clients and have never witnessed any aggressive acts towards clients or other staff members. The family members of the clients involved would not return requests for interviews. Based on the evidence gathered the allegation, Facility staff threatened to hit client, is deemed to be unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted, and a copy of the report was provided.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021

LIC9099 (FAS) - (06/04)

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