306004054-8-4-2022-22-AS-MVAO-CHSUPQ-20220830154556

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004054
Report Date: 06/17/2022
Date Signed: 08/04/2022 09:55:42 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
10/20/2021 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-NP-20211020110447

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:	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 2	DATE:	06/17/2022
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Lolita Santiago - Caregiver		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Facility is not providing adequate care and supervision for the clients in care
Facility is not providing healthy meals for the clients in care

INVESTIGATION FINDINGS:

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

On today's visit LPA Velazquez interviewed Resident (R) #2 and staff present. LPA Velazquez along with DSP Santiago conducted a tour of the physical plant. The facility was observed to be clean and in good repair in the areas observed. LPA and DSP also observed an adequate supply of perishable and non-perishable food supply with fruits and vegetables present. During the course of the investigation LPA reviewed facility, staff, and resident records. LPA also conducted interviews with the complainant, residents and staff. The individuals interviewed provided conflicting statements and the allegations could not be corroborated. Records reviewed included sample menus, staff training records, resident roster, staff work schedules, Consumer Face

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

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-NP-20211020110447

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: 06/17/2022

NARRATIVE

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Sheet, Admission Agreements, Physician's Reports, and Individual Program Plans (IPPs), and Administrator Certificate. DSP Lolita Santiago lives in the facility and is a live-in Caregiver. DSP Santiago indicated she is available to tend to the needs of the residents throughout the night.

Regarding the allegation: Facility is not providing adequate care and supervision for the clients in care, both residents in care were interviewed and indicated that S2 provides adequate care and supervision at all times. Both residents also indicated they have never been left alone in the home without the presence of a caregiver. Both residents further indicated that if they need any assistance at night they have been instructed to knock and S2's bedroom door. Per the 2 residents S2 then proceeds to assist them with whatever the needs the residents may have. When interviewed, S2 indicated she has never told the residents not to bother her in the evenings or at any time overnight. S2 further indicated she has always told the residents if they need assistance at night to come knock on their door and they will assist the residents with whatever the needs the residents may have. S2 indicated there have been several occasions where a resident knocked on her door and she provided the resident the assistance they required each time.

Regarding the allegation: Facility is not providing healthy meals for the clients in care, both residents in care indicated they were extremely satisfied with the meals prepared for them by the caregivers and felt the caregivers were good cooks. Both residents indicated they are provided with a variety of meal choices such as chicken, pork and beef with vegetables and potatoes or rice. Both residents indicated they are provided snacks such as fruit, pudding, cookies, crackers, and yogurt. Both residents indicated their lunches include sandwiches, fruit, yogurt, and water. S2 also indicated they prepare and serve a variety of meals such as chicken, pork and beef with vegetables and potatoes or rice. S2 indicated they provide the residents a variety of snacks that include various fruits as well as cookies.

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 allegations: Facility is not providing adequate care and supervision for the clients in care and Facility is not providing healthy meals for the clients in care are 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: Luz Adams	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

LIC9099 (FAS) - (06/04)

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