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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004295
Report Date: 05/13/2024
Date Signed: 05/13/2024 04:11:01 PM

Substantiated


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
05/06/2024 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240506082348
FACILITY NAME:NELDYS ADULT RESIDENTIAL CARE HOMEFACILITY NUMBER:
306004295
ADMINISTRATOR:JON NEIL CASTROFACILITY TYPE:
735
ADDRESS:11411 STANFORD AVENUETELEPHONE:
(714) 539-5151
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:6CENSUS: 4DATE:
05/13/2024
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Paul ArcinasTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Staff are operating out of ratio
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Staff #1 (S1) Paul Arcinas, discussed the purpose of the inspection, and explained the allegation.

The investigation into the allegation that staff are operating out of ratio revealed the following: During the course of the investigation, LPA inspected the facility, interviewed clients and staff, and obtained and reviewed copies of the client roster, staff roster, and the facility’s staff schedules since March 22, 2024.

Regarding the allegation that staff are operating out of ratio: it was alleged that the facility is not following the staff ratio required by the regional enter. LPA interviewed four clients and did not obtain information corroborating this allegation. LPA interviewed three staff who reported that the staffing ratio required by the regional center is one staff for each two clients.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024
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 6
Control Number 22-AS-20240506082348
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: NELDYS ADULT RESIDENTIAL CARE HOME
FACILITY NUMBER: 306004295
VISIT DATE: 05/13/2024
NARRATIVE
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Staff stated that during the day shifts there are two staff on duty whenever there are four clients present and that during the overnight shift there is one staff on duty while the clients are sleeping. However, LPA reviewed the facility’s staff schedules since March 22, 2024 which shows that on April 21, 2024, May 11, 2024, and May 12, 2024, there was only one staff on duty from 6PM to 12AM while all four clients were present. Per staff interviews, the clients generally go to sleep around 8PM, meaning all four clients were present at the facility and awake while only one staff was on duty. The information obtained corroborated this allegation.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 22-AS-20240506082348
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: NELDYS ADULT RESIDENTIAL CARE HOME
FACILITY NUMBER: 306004295
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2024
Section Cited
CCR
85065(b)
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85065 Personnel Requirements (b) The licensee shall employ staff as necessary to ensure provision of care and supervision to meet client needs. This requirement was not met as evidenced by:
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Licensee stated they will create a new schedule ensuring at least two staff on duty any time all four clients are present and awake at the facility and will submit proof to LPA by POC due date.
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Based on interviews and documents, the licensee did not employ sufficient staff to meet client needs by not meeting the regional center ratio, which poses a potential personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
05/06/2024 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240506082348

FACILITY NAME:NELDYS ADULT RESIDENTIAL CARE HOMEFACILITY NUMBER:
306004295
ADMINISTRATOR:JON NEIL CASTROFACILITY TYPE:
735
ADDRESS:11411 STANFORD AVENUETELEPHONE:
(714) 539-5151
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:6CENSUS: 4DATE:
05/13/2024
UNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Paul ArcinasTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Staff are financially abusing residents
Staff did not provide adequate food service
Staff did not provide a comfortable temperature for residents
Staff did not administer residents' medication as prescribed
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegations. LPA met with Staff #1 (S1) Paul Arcinas, discussed the purpose of the inspection, and explained the allegations.

The investigation into the allegations that staff are financially abusing residents, staff did not provide adequate food service, staff did not provide a comfortable temperature for residents, and staff did not administer residents' medication as prescribed revealed the following: During the course of the investigation, LPA inspected the facility, interviewed clients and staff, and obtained and reviewed copies of the client roster, staff roster, the facility’s Record of Client’s Safeguarded Cash Resources (LIC405) since March 2024, the facility’s grocery receipts for March and April 2024, and the facility’s Medication Administration Records for April and May 2024.

CONTINUED
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 22-AS-20240506082348
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: NELDYS ADULT RESIDENTIAL CARE HOME
FACILITY NUMBER: 306004295
VISIT DATE: 05/13/2024
NARRATIVE
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Regarding the allegation that staff are financially abusing residents: it was alleged that staff are mishandling clients’ money. LPA interviewed four clients and did not obtain information corroborating this allegation. LPA interviewed three staff and did not obtain information corroborating this allegation. LPA reviewed the facility’s Record of Client’s Safeguarded Cash Resources (LIC405) since March 2024 for all four clients, confirmed the ledgers matched the cash resources present for each client, and noted no errors or suspicious charges. The information obtained did not corroborate the allegation.

Regarding the allegation that staff did not provide adequate food service: it was alleged that staff are not buying food for the clients, almost every day clients have to buy their own meals, and most of the food purchased is for the staff. LPA interviewed four clients and did not obtain information corroborating this allegation. LPA interviewed three staff and did not obtain information corroborating this allegation. LPA inspected the kitchen and observed it to be clean and organized and the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA reviewed the facility’s grocery receipts for March and April 2024 which shows the facility spent $3,099.80 on groceries for March and April 2024. LPA reviewed the facility’s Record of Client’s Safeguarded Cash Resources (LIC405) since March 2024 for all four clients and noted regular purchases at restaurants by clients. However, interviews revealed that the clients enjoy eating out at restaurants and do so voluntarily, the clients also enjoy the food cooked by the facility, and the clients are receiving all of their meals and enjoy being able to choose their foods. The information obtained did not corroborate the allegation.

Regarding the allegation that staff did not provide a comfortable temperature for residents: it was alleged that the facility lacks air conditioning, making it humid inside. LPA interviewed four clients and did not obtain information corroborating this allegation. LPA interviewed three staff and did not obtain information corroborating this allegation. LPA observed the temperature in the facility to be comfortable and that the facility contains two large portable air conditioners in the living room and kitchen area as well as two small room air conditioners in two of the client bedrooms. LPA confirmed all of the air conditioners are functioning. The information obtained did not corroborate the allegation.

CONTINUED
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20240506082348
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: NELDYS ADULT RESIDENTIAL CARE HOME
FACILITY NUMBER: 306004295
VISIT DATE: 05/13/2024
NARRATIVE
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Regarding the allegation that staff did not administer residents' medication as prescribed: it was alleged that medication is not being administered properly to clients. LPA interviewed four clients and did not obtain information corroborating this allegation. LPA interviewed three staff and did not obtain information corroborating this allegation. LPA reviewed the facility’s Medication Administration Records (MAR) for April and May 2024 for all four clients and inspected the medications for all four clients and confirmed the MAR properly documents the medications administered and that the medications were administered following doctors’ orders. The information obtained did not corroborate the allegation.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are 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 and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6