306004477-9-22-2023-22-AS-SSAS-CVWQ3T-20230922114916

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004477
Report Date: 09/18/2023
Date Signed: 09/22/2023 11:42:06 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/08/2020 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200908140149

FACILITY NAME:	ROSIE HALL FAMILY HOME		FACILITY NUMBER:	306004477
ADMINISTRATOR:	KARRY VALLEJO		FACILITY TYPE:	735
ADDRESS:	2031 S. ARTESIA STREET		TELEPHONE:	(714) 831-1336
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY:	4	CENSUS: 4	DATE:	09/18/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Karry Vallejo, administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility staff is stealing client's medication

INVESTIGATION FINDINGS:

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REPORT AMENDED TO MODIFY CONFIDENTIALITY STATUS - On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct a follow up on the investigation of the allegation listed above. LPA was greeted and granted entry by facility adiministrator Karry Vallejo after explaining the purpose of the visit. LPA then listed the allegations investigated at this time.

A previous phone inspection was conducted via telephone by LPA Lydia Martinez on September 10, 2020 due to COVID restrictions in place at the time. Extensive client records, Personal and Incidental (P&I) funds records and medication administration records were provided by facility staff at this time.

During the present visit, LPA requested, obtained and reviewed records for all clients admitted at this time. P&I balances were confirmed to match the cash amounts on hand for all four clients and full ledgers were provided by administrator via email.
CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023

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-20200908140149

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ROSIE HALL FAMILY HOME	FACILITY NUMBER: 306004477
	VISIT DATE: 09/18/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099
LPA reviewed the centrally stored medication for all clients present, including quantity, doses, physician orders, administration records and destruction records. A full review of medication on hand is conducted every three months, with the latest documented review dated July 2023. All medication is bubble-wrapped and marked with the planned day of administration. The quantities observed are consistent with the doses prescribed and no inconsistencies are observed within the central storage as well as within the documentation provided.

Additional interviews were conducted or attempted with the four clients admitted at this time.

Regarding the allegation that Facility staff is stealing client's medication, the following was concluded: Based on observation, interviews and a review of facility records, all medications prescribed are accounted for and/or documented as administered to clients. Client interviews confirmed that clients are receiving their treatment as prescribed. Therefore the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or may be valid; there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with Administrator Karry Vellejo and a copy of this report was provided to a facility representative.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023

LIC9099 (FAS) - (06/04)

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