306004138-1-20-2023-22-AS-SSAS-CNL5VD-20230130191723

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004138
Report Date: 01/20/2023
Date Signed: 01/20/2023 02:04:02 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
09/21/2022 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220921170853

FACILITY NAME:	SANTOS HOME		FACILITY NUMBER:	306004138
ADMINISTRATOR:	CRISTINA SANTOS		FACILITY TYPE:	735
ADDRESS:	11731 DEBBIE LANE		TELEPHONE:	(714) 621-0355
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92840
CAPACITY:	6	CENSUS: 5	DATE:	01/20/2023
		ANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Mariacorazon Demaclid, caregiver Martha Losoya, house manager (by telephone)		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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1/ Client is not provided with food as requested/needed.

2/ Client is verbally harrassed by multiple members of staff.

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the allegations listed above. LPA was greeted and granted entry by Mariacorazon Demaclid, caregiver after explaining the purpose of the visit. House manager Martha Losoya was notified by telephone and reviewed the report remotely with LPA.

Complaint investigation visits were previously conducted on September 28, 2022 and November 22, 2022
with LPA Alvaro Ramirez Jr. Three (3) staff were interviewed and five (5) clients interviews were conducted or attempted. A review of records including meal plans/menus as well records for all clients present at the facility (medical and behavior folders).

LPA toured the physical plant with facility staff during both visits and was able to extensively observe staff interacting with clients and providing assistance with tasks of daily living including using the restrooms, getting food and participating in activities. CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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-20220921170853

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SANTOS HOME	FACILITY NUMBER: 306004138
	VISIT DATE: 01/20/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099

Three out of three clients interviewed confidentially stated that they had no direct or indirect knowledge of any harassing behavior by a direct care staff while they were at the facility. Three of out three staff members interviewed during the two facility visits also deny having witnessed any inappropriate speech or behavior by any of their coworkers.

Clients were observed by LPAs to be free to ambulate around the facility as they please. Wheelchair bound residents were also observed to be assisted from the common areas to the restrooms, or from their bedrooms to the common areas on multiple instances. LPAs did not observe any instance of staff members voluntarily restricting the client's movements at the facility or harassing clients.

During multiple tours of the physical plant conducted by LPAs, an ample food supply was noted as being accessible, and meal plans appear to indicate a sufficient provision of food. Snacks are also stated by a majority of interviewees as available either upon request or offered at specific times during the day, including but not limited to clients that are non-verbal.

Although the allegation that the Client is not provided with food as requested/needed and that Client is verbally harassed by multiple members of staff may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed unsubstantiated.

An exit interview was conducted and a copy of this report was provided and left at the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC9099 (FAS) - (06/04)

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