306004294-5-31-2024-22-AS-AJLO-D6FSZD-20240621141854

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004294
Report Date: 05/31/2024
Date Signed: 05/31/2024 09:09:08 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 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
05/02/2024 and conducted by Evaluator Dwayne L Mason

COMPLAINT CONTROL NUMBER: 22-AS-20240502160252

FACILITY NAME:	KRYSTAL ADULT RESIDENTAL CARE HOME		FACILITY NUMBER:	306004294
ADMINISTRATOR:	JON CASTRO		FACILITY TYPE:	735
ADDRESS:	2525 E. HILDA PLACE		TELEPHONE:	(714) 774-6587
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92806
CAPACITY:	6	CENSUS: 6	DATE:	05/31/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	House Manager - Gerry Garino		TIME COMPLETED:	09:23 AM

ALLEGATION(S):

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Client was not allowed to refuse services

INVESTIGATION FINDINGS:

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This unannounced investigation inspection by Licensing Program Analyst (LPA) Dwayne Mason Jr. is being conducted to conclude this agency’s investigation in the complaint allegation(s) mentioned above. LPA arrived at the facility and was greeted by House Manager (HM), Gerry Garino. LPA met with HM and explained the nature of the inspection. Administrator (AD) Jon Castro was present via phone call.

The department received a complaint on 5/2/2024 alleging the facility staff did not allow a client to refuse services. The Reporting Party (RP) disclosed that facility staff forced Client 1 (C1) onto a bus in spite of the client refusing services. During the investigation, the department interviewed Administrator, staff, clients in care, day program staff and Service Coordinator.

(continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L Mason	TELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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-20240502160252

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: KRYSTAL ADULT RESIDENTAL CARE HOME	FACILITY NUMBER: 306004294
	VISIT DATE: 05/31/2024

NARRATIVE

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(continued from LIC9099)

On 5/7/2024 LPA conducted interviews with Administrator (AD), clients in care and staff. During interviews, Administrator and staff denied staff forced a client onto a bus and made no disclosures regarding the allegation. LPA attempted to interview Clients 1, 2, 3, and 4 and was unable to due to clients being non-verbal.

LPA obtained copies of the staff roster, staff schedule, client roster, personal rights acknowledgments, individual program plans and day program annual reports.

On 5/20/2024, LPA conducted a collateral visit at Easterseals Adult Day Services (#306006002), where C1 receives services. LPA conducted interview with Job Coach (JC) on 5/21/2024. JC denied witnessing staff force C1 onto the bus and made no disclosures regarding the allegation. On 5/21/2024, LPA conducted interview with C1’s Service Coordinator (SC). SC confirmed facility staff were in attendance of C1’s last Annual Meeting and made no disclosures about the allegation.

LPA contacted OCTA to attempt to conduct an interview with the ACCESS bus driver. LPA spoke to staff at OCTA on 5/24/24 and 5/28/24. LPA was notified that OCTA had to gain approval to provide contact information and that they would contact LPA. LPA was not contacted back by OCTA.

Due to conflicting information received during interviews conducted, LPA was unable to determine if staff did not allow C1 to refuse services. Based on interviews conducted and records reviewed there is insufficient evidence to support the allegation. Although the allegation(s) may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and this report was reviewed with House Manager. A copy of this LIC-9099 was provided to the facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L Mason	TELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

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