306004110-6-28-2022-22-AS-SSAS-CHN3WP-20220825183704

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004110
Report Date: 06/28/2022
Date Signed: 06/28/2022 12:41:21 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
10/15/2021 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211015171310

FACILITY NAME:	ALL STAR ELDERLY CARE		FACILITY NUMBER:	306004110
ADMINISTRATOR:	EDUARDO ELEAZAR		FACILITY TYPE:	740
ADDRESS:	22678 GENOVA		TELEPHONE:	(949) 837-1504
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	5	CENSUS: 3	DATE:	06/28/2022
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Loida Eleazar		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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-Facility is unsanitary
-Facility is messy
-Residents are left unattended while in care.
-Residents was not accorded privacy while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegations. LPA arrive at facility was greeted at the door by Eduardo Eleazar, Administrator and granted entry. LPA spoke with Loida Eleazar, Administrator and explained the purpose of the visit.

Findings are based upon this investigation which included interviews conducted, tour of physical plant of facility and review of records.

It is alleged that facility is unsanitary, and facility is messy. LPAs Martinez and Thompson-Gracia conducted a visit on 10/25/2021 did not observe facility to be unsanitary or messy. At the time of visit LPAs observed facility being sanitized and cleaned. It was observed facility restrooms had just been cleaned as well. There was no

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

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-20211015171310

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: ALL STAR ELDERLY CARE	FACILITY NUMBER: 306004110
	VISIT DATE: 06/28/2022

NARRATIVE

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observation that sofa, chairs and table to have clutter. LPA Martinez did not observed facility living room sofa to have a plank or plywood on it. It was observed that sofa had a cover and three cushions on it. Dining room table had a bowl with fruit and no old or expired food was observed on it. LPA Martinez inspected the food supply and observed no expired perishable and non-perishables in the facility. There was a minimum of one week of non-perishables food and two days of perishable foods available. It is alleged that residents are left unattended while in care. Based on interviews conducted with residents it was indicated that there is always at least one caregiver at the facility. There was no indication by interviews that residents are left unattended while in care. Residents stated that they receive the care they need and/or care being requested by them. Per interviews conducted with facility staff it was indicated that there are always two staff unless one needs to leave to do grocery shopping, facility errands or to go to the pharmacy. It is alleged that resident was not according privacy while in care. Interviews conducted with residents revealed that they have never observed being able to see inside the restroom when being used. Resident indicate that they are able to go to restroom independently. Interviews with staff revealed that all resident are able to use the restroom unassisted and when residents need assistance that staff are able to hear them. Staff indicated that residents generally let staff know when they are going to use the restroom which allows staff to be aware. Base on the information received from interviews, and the lack of corroborating witnesses to the incidents, LPA is unable to determine if the alleged violations occurred as reported.

Based on the information mentioned above, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated.

An exit interview was conducted with facility representatives and a copy of this LIC9099 report was left at facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

LIC9099 (FAS) - (06/04)

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