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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004079
Report Date: 10/12/2023
Date Signed: 10/12/2023 02:13:29 PM

Unfounded


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
03/29/2023 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20230329100335
FACILITY NAME:ANGELA'S RESIDENTIAL CAREFACILITY NUMBER:
306004079
ADMINISTRATOR:ANGELA TALPOS O'CONNORFACILITY TYPE:
740
ADDRESS:3141 BRAY LANETELEPHONE:
(949) 326-8797
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:6CENSUS: 4DATE:
10/12/2023
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Angela Talpos O'ConnorTIME COMPLETED:
02:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility not allowing resident to use call bell.
Facility forced resident to eat.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility, interviewed staff and residents as well as reviewed and obtained pertinent documentation such as physician report. Regarding the allegations that facility forced resident to eat and facility not allowing resident to use call bell, the investigation revealed the following: LPA observed all residents with call buttons as well as the call button system. Four out of four staff and five out of five residents confirm using their call button and staff responding for assistance. Four out of four staff and five out of five residents deny residents are being forced to eat. Administrator denies all allegations as well. Staff indicate encouraging the residents to eat but they are not forced. Therefore the allegations are deemed UNFOUNDED, meaning the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to facility representative.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
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
03/29/2023 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20230329100335

FACILITY NAME:ANGELA'S RESIDENTIAL CAREFACILITY NUMBER:
306004079
ADMINISTRATOR:ANGELA TALPOS O'CONNORFACILITY TYPE:
740
ADDRESS:3141 BRAY LANETELEPHONE:
(949) 326-8797
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:6CENSUS: 4DATE:
10/12/2023
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Angela Talpos O'ConnorTIME COMPLETED:
02:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility handled resident in a rough manner
Facility shoved resident
Resident is being verbally abused while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility as well as interviewed staff and residents. Regarding the allegations that resident is being verbally abused while in care, facility shoved resident, and facility handled resident in a rough manner, the investigation revealed the following: Facility appears clean and sanitary with no health or safety concerns. LPA observed residents eating and relaxing in the facility. All residents appeared clean and well taken care of with no visible signs of abuse. Four out of five residents and four out of four staff deny any physical or verbal abuse occurring in the facility. All residents stated satisfaction with services and treatment at the facility. Due to conflicting information, LPA is unable to corroborate allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report was provided. *This is an amended report indicating a change in verbiage.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2