306004054-6-24-2022-22-AS-SSAS-CHLV9A-20220824161402

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004054
Report Date: 06/24/2022
Date Signed: 06/24/2022 10:15:20 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
03/23/2021 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210323135515

FACILITY NAME:	VICTOR GUEST HOME		FACILITY NUMBER:	306004054
ADMINISTRATOR:	AUGUSTUS A. TORRES		FACILITY TYPE:	740
ADDRESS:	24552 TROY STREET		TELEPHONE:	(949) 215-0619
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 2	DATE:	06/24/2022
		UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Lolita Santiago - Direct Support Professional		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility not allowing client to have scheduled observations per agreement since November 2020.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Patricia Velazquez conducted a subsequent complaint visit to investigate the above allegation and deliver the findings of the investigation. LPA Velazquez was allowed entry into the facility and met with Direct Support Professional (DSP) Lolita Santiago.

On today's visit LPA Velazquez conducted a tour of the physical plant along with DSP Santiago. The 2 residents in care were not present in the facility at the time of this visit as one had gone to work and the other had gone to Day Program.

During the course of the investigation LPA Velazquez reviewed email communication, facility, staff, and resident records. LPA Velazquez also conducted interviews with the complainant, staff and residents. The individuals interviewed provided conflicting statements and were not able to corroborate the above allegation. The complainant did indicate that communications between the facility and Vocational Visions Day Program

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022

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-20210323135515

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: VICTOR GUEST HOME	FACILITY NUMBER: 306004054
	VISIT DATE: 06/24/2022

NARRATIVE

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did eventually transpire. The records reviewed included a Physician's Report, Individual Program Plan (IPP), Medical Appointment Log, Resident Appraisal, Staff Training Records, Email Communication between Administrator Augustus Torres and Vocational Visions Day Program staff, Email Communication between the Regional Center Orange County Service Coordinator and Vocational Visions Day Program staff, Letters of Conservatorship, A Special Incident Report from the Regional Center Orange County documenting the Resident's death, and a Death Report.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the following allegation: Facility not allowing client to have scheduled observations per agreement since November 2020 is deemed UNSUBSTANTIATED.

An exit interview was conducted with Direct Support Professional Lolita Santiago and a copy of this report along with the LIC 811s were provided at the time of this visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022

LIC9099 (FAS) - (06/04)

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