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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004367
Report Date: 04/21/2022
Date Signed: 04/21/2022 03:16:52 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
04/14/2022 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220414144649
FACILITY NAME:ARFEL CARE HOME 1FACILITY NUMBER:
306004367
ADMINISTRATOR:ARIEL WATINFACILITY TYPE:
735
ADDRESS:8881 PIERCE DRIVETELEPHONE:
(714) 827-7188
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:6CENSUS: 6DATE:
04/21/2022
UNANNOUNCEDTIME BEGAN:
02:21 PM
MET WITH:Ariel Watin, Felita ValenzuelaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility refrigerator is inaccessible to the clients.
INVESTIGATION FINDINGS:
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Licensing Program Analysts Joseph Alejandre and Celine De Perio made an unannounced visit to conduct the required 10-day complaint visit to begin the investigation into the allegation listed above. LPAs were greeted and granted entry by the facility staff. LPAs explained the reason for the visit. LPAs met with Administrator Areil Watin and Assistant Administrator Felita Valenzuela. The investigation into the allegation, facility refrigerator revealed the following; on 4/5/22 it was alleged the refrigerator was made inaccessible to clients. The refrigerator was locked on 4/5/22 because client 1 (C1) was to have a medical procedure the following day which required they did not eat for 12 hours. Staff interviewed verified the refrigerator was locked and food was made inaccessible to C1. Staff reported that other clients did have access to food by requesting it from staff. At the time of the visit the refrigerator was unlocked and all clients had access to the refrigerator. Based on the evidence gathered through interviews the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations, Title 22, Division 6. An exit interview was conducted and a copy of this report along with citations and Appeal Rights was provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
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
Control Number 22-AS-20220414144649
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: ARFEL CARE HOME 1
FACILITY NUMBER: 306004367
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/22/2022
Section Cited
CCR
80072(a)(3)
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To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating...
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Licensee states the refrigerator will not be locked and will remain accessible to clients in care at all times and staff will be retrained on the personal rights of clients. Licensee to forward proof to LPA by POC due date.
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This requirement is not being met as evidenced by; based on evidence gathered through interviews the refrigerator was locked and made inaccessible to clients in care on 4/5/22. This poses an immediate health and safety risk to clients 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: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
LIC9099 (FAS) - (06/04)
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