306004079-4-4-2023-22-AS-SSAS-CR3R7Q-20230420124641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004079
Report Date: 04/04/2023
Date Signed: 04/04/2023 10:52:07 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
03/27/2023 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230327143501

FACILITY NAME:	ANGELA'S RESIDENTIAL CARE		FACILITY NUMBER:	306004079
ADMINISTRATOR:	ANGELA TALPOS O'CONNOR		FACILITY TYPE:	740
ADDRESS:	3141 BRAY LANE		TELEPHONE:	(949) 326-8797
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	6	CENSUS: 5	DATE:	04/04/2023
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Angela Tolpos O'Connor		TIME COMPLETED:	11:05 AM

ALLEGATION(S):

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Staff yell at residents
Staff speak to residents in a demeaning manner
Staff dispensed medication to a resident without a prescription
Staff pulled resident in an aggressive manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced initial 10 day complaint visit to initiate the investigation into the above allegations and to deliver the findings of the investigation. LPA Velazquez was allowed entry into the facility and met with Administrator Angela T. O'Connor and explained the purpose of the visit.

On today's visit LPA Velazquez conducted interviews with residents and staff. LPA Velazquez also reviewed and obtained copies of facility and resident records. Upon arrival LPA observed the 5 residents in care having breakfast at the dining table. The residents appeared well-groomed with no visible injuries observed. During the course of the investigation the following was revealed: LPA Velazquez conducted interviews with residents and staff. Seven of seven individuals interviewed provided conflicting statements and could not corroborate any of the above allegations. Five of five individuals interviewed stated they well-cared for by the Caregivers in the facility, denied ever being yelled at or spoken to in a demeaning manner or handled in an aggressive manner.

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: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

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-20230327143501

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: ANGELA'S RESIDENTIAL CARE	FACILITY NUMBER: 306004079
	VISIT DATE: 04/04/2023

NARRATIVE

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At 9:47 AM LPA Velazquez along with Administrator O'Connor conducted a medication review for the 5 residents in care. The facility documented the resident medications utilizing the Centrally Stored Medication and Destruction Record where all of the resident medications were properly documented. All of the resident medications were properly labeled. LPA Velazquez reviewed resident records including Physician's Reports, Identification and Emergency Information, and Centrally Stored Medication and Destruction Records. Two of two individuals interviewed stated they only administer medications to residents per the doctor's orders and denied administering medication without a prescription.

Based on the observations made by LPA Patricia Velazquez, interviews which were conducted and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the following allegations: Staff yell at residents, Staff speak to residents in a demeaning manner, Staff dispensed medication to a resident without a prescription, and Staff pulled resident in an aggressive manner are all deemed UNSUBSTANTIATED.

An exit interview was conducted with Administrator Angela T. O'Connor and a copy of this report was 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: 04/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023

LIC9099 (FAS) - (06/04)

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