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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004530
Report Date: 06/03/2025
Date Signed: 06/03/2025 05:09:27 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
05/27/2025 and conducted by Evaluator Michael Tea
COMPLAINT CONTROL NUMBER: 22-AS-20250527125952
FACILITY NAME:PRIME CARE MANORFACILITY NUMBER:
306004530
ADMINISTRATOR:ABDOL ARASTOOFACILITY TYPE:
735
ADDRESS:8592 LAMPSON AVENUETELEPHONE:
(714) 534-4457
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:26CENSUS: 26DATE:
06/03/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Abdol ArastooTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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- Staff do not ensure the facility is clean and sanitary
- Staff did not provide adequate food service
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conduct a complaint investigation. LPA Tea was greeted and granted entry by Administrator (AD) Abdol Arastoo.

The department received a complaint on May 27, 2025 and LPA Tea conducted the initial 10 day visit a week later on June 3, 2025. It was alleged that staff do not ensure the facility is clean and sanitary and staff did not provide adequate food service. LPA Tea interviewed facility staff and clients, made observations and collected pertinent documents such as staff and resident rosters. The investigation determined the following:

It was alleged that staff do not ensure the facility is clean and sanitary. During the investigation LPA interviewed clients and facility staff, made observations and asked for pertinent documents. The investigation determined the following: Per interview with AD Arastoo the facility is maintained every day,
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
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 3
Control Number 22-AS-20250527125952
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: PRIME CARE MANOR
FACILITY NUMBER: 306004530
VISIT DATE: 06/03/2025
NARRATIVE
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staff clean the facilities throughout their shift. AD Arastoo and LPA Tea toured the facility to check the cleanliness and sanitation of the facility. LPA observed the facility being clean and well maintained. There is no dirt or grime in the bathrooms and common areas. The floors were clean and mopped everyday and throughout the day as needed. Two out of two staff interviewed said part of their job is cleaning and maintaining the facility. The staff said there are different shifts throughout the day, there are three shifts. If the staff does not take care of some of the stuff, the next shift will take care of it. One staff notice that nocturnal staff tends to not clean well like other shifts. The staff interviewed usually cleans up after them in the morning, but today they did a better job than usual in cleaning the facility during their shift. Eight out of eleven clients interviewed said the facility does a good job in cleaning and sanitizing the facility. The clients see the staff cleaning every day and said they do a good job with cleaning the bathrooms. Some clients notice that day staff tend to clean better than the nocturnal shift. One client mention that staff have bad communication with each other in getting things done for the facility.

It was alleged that staff did not provide adequate food service. During the investigation LPA interviewed clients and facility staff, made observations and asked for pertinent documents. The investigation determined the following: AD Arastoo said there is plenty of food for the clients. AD Arastoo led LPA Tea to the kitchen to observe the food supply. LPA Tea observed the facility having enough non-perishable and perishable food for the clients in care. The kitchen pantries and shelves were fully stocked with food. LPA also observed the facility's two industrial refrigerators to be filled with food for clients. Per interviews with the staff, both staff spoken to said there is enough food for the clients. They serve three meals throughout the day and snacks as well. One staff showed the facilities weekly menu posted in the kitchen area that always changes and is updated. Both staff stated that if clients missed a meal, that clients can notify beforehand to save them a plate, but it is their responsibility to do so. Eight out of eleven clients interviewed said the food service was good. Clients mostly said the food quality was good and there was variety in the meals prepared. Some clients said the servings were too small or limited when they wanted more but it could be due to limited resources.

Therefore, based on LPA Tea's observations and interviews conducted and records reviewed the allegations that staff do not ensure the facility is clean and sanitary and staff did not provide adequate food service has been determined to be unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.



Complaint investigation report continued on LIC9099-C
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250527125952
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: PRIME CARE MANOR
FACILITY NUMBER: 306004530
VISIT DATE: 06/03/2025
NARRATIVE
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No deficiencies cited at this time and an exit interview was conducted with AD Arastoo. A copy of the report was provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3