306004514-7-22-2024-22-AS-LMOA-D8M286-20240829170945

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004514
Report Date: 07/22/2024
Date Signed: 07/22/2024 04:40:24 PM

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
04/14/2021 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210414143207

FACILITY NAME:	NORTHWOOD CARE HOME		FACILITY NUMBER:	306004514
ADMINISTRATOR:	TERESA ALPUERTO		FACILITY TYPE:	740
ADDRESS:	7 BRAGG		TELEPHONE:	(949) 653-5742
CITY:	IRVINE	STATE: CA	ZIP CODE:	92620
CAPACITY:	6	CENSUS: 2	DATE:	07/22/2024
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Theresa Alpuerto Danilo De Guzman		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Administrators wife yelled at client
Client blamed for employees quitting by administrator wife

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit regarding the complaint allegations above. LPA Haley was gretted, granted entry and explained the reason for the visit before entering the facility. During the visit LPA Haley conducted two additional interviews before delivering findings on the complaint allegations.

Regarding the allegation: Administrators wife yelled at client

4 of 5 individuals interviewed denied the complaint allegation. According to two of the staff that were interviewed, Staff 2 (S2) had a discussion with Resident 1 (R1) regarding R1’s behavior and how R1 was treating staff. According to Staff 3 (S3), S2 had a conversation with R1 regarding R1’s behavior and denied S2 was yelling. “If (S2) was yelling we would hear it.” According to Staff 4 (S4), S2 had a discussion with R1 and the mother of R1 regarding the R1’s behavior, and denied S2 was yelling at R1. “No. From my understanding, they had a conversation with (R1). R1’s behaviors were bad.”
Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024

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-20210414143207

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: NORTHWOOD CARE HOME	FACILITY NUMBER: 306004514
	VISIT DATE: 07/22/2024

NARRATIVE

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Document review revealed emotional outburst and property destruction were some of R1’s challenging behaviors.

Regarding the allegation: Client blamed for employees quitting by administrator wife.

4 of 5 individuals interviewed denied the allegation. All the staff interviewed denied any staff quit because of Resident 1 (R1). 4 staff denied R1 was blamed for staff quitting. Three staff members stated the former staff who left, found a better opportunity. S1 said the former staff left for the DMV or something. Staff 4 (S4) said the former staff didn’t want to continue in this line of work and thinks the former staff is working a county job. Document review revealed a former staff member resigned for a better opportunity. Staff 3 (S3) stated another former staff member left the facility to pursue the military because the staff was young and wanted to do different things. S3 also revealed the former staff who left for the military left after R1 moved out.

Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the 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, the allegations are deemed Unsubstantiated.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024

LIC9099 (FAS) - (06/04)

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