306004634-4-26-2024-22-AS-SSAS-D4TVQ2-20240430163735

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004634
Report Date: 04/26/2024
Date Signed: 04/26/2024 03:53:09 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
11/10/2020 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201110111240

FACILITY NAME:	NEW LIFE HOMES 2		FACILITY NUMBER:	306004634
ADMINISTRATOR:	MA. VICTORIA E. HERNANDEZ		FACILITY TYPE:	735
ADDRESS:	1855 S. WEST STREET		TELEPHONE:	(714) 740-1794
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92802
CAPACITY:	6	CENSUS: 3	DATE:	04/26/2024
		UNANNOUNCED	TIME BEGAN:	01:06 PM
MET WITH:	Normando Surio-Administrator		TIME COMPLETED:	04:08 PM

ALLEGATION(S):

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Client was hit with a chair by another client
Facility did not seek medical treatment for client

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on November 10, 2020. LPA was greeted and granted entry into the facility and met with Administrator (AD) Normando Surio. LPA explained the reason for the visit.

This agency has investigated the complaint alleging that client was hit with a chair by another client. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: During the investigation LPA reviewed documents including the Regional Center of Orange County (RCOC) Incident Report dated November 09, 2020. Per Incident Report Resident 1 (R1) was struck in the head and upper arm with a chair by R2. During the course of the interviews AD Victoria Hernandez reported that R1 and R2 were arguing while playing cards. Per AD R1 did not want to play anymore and threw the cards at R2. R2 got mad and threw a slipper and a chair at R1. During the course of the interviews with staff, Staff 1 (S1) reported that during the incident that a
CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024

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-20201110111240

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: NEW LIFE HOMES 2	FACILITY NUMBER: 306004634
	VISIT DATE: 04/26/2024

NARRATIVE

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staff put their hand in front of R1's face in order to prevent the chair from hitting R1. Per S1 R1 sustained a small red spot in their head and stated that staff applied First-Aid and ice on the red spot. Documents reviewed by LPA included the 30-Day Eviction dated October 07, 2020 for R1. Per 30-Day Eviction R1's behavior counts are increasing dramatically since September 1, 2020, and his behaviors are getting more intense and longer in duration. Per AD R1 requested to move out if the facility and moved out at the end of 2021. During the investigation LPA reviewed documents including the staff Nonviolent Crisis Intervention training program valid from June 2019 to June 2021.

Regarding the allegation that facility did not seek medical treatment for client, the investigation revealed the following: During the course of the interviews with staff, S1 reported that R1 was assessed by staff and stated that R1 did no complained about having pain. Documents reviewed included the Physician Report (LIC602) dated November 18, 2020 for R1. Per Physician report R1 is able to communicate their needs. During the course of the interviews AD stated that due to R1 sustaining a minor injury that R1 did not need to go to the Emergency Room.

Based on LPA's observation and information gathered during the investigation, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, the allegations are deemed UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with AD Surio, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024

LIC9099 (FAS) - (06/04)

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