306004655-6-16-2023-22-AS-SSAS-CTGT2B-20230706142028

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004655
Report Date: 06/16/2023
Date Signed: 06/16/2023 01:44:28 PM

Unfounded

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
06/12/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230612122110

FACILITY NAME:	LAS ESTANCIAS ASSISTED CARE		FACILITY NUMBER:	306004655
ADMINISTRATOR:	CELIA RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	1409 WHITTIER AVENUE		TELEPHONE:	(714) 488-9995
CITY:	BREA	STATE: CA	ZIP CODE:	92821
CAPACITY:	6	CENSUS: 5	DATE:	06/16/2023
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Facility Administrator - Celia Rodriguez		TIME COMPLETED:	02:07 PM

ALLEGATION(S):

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Staff did not allow resident to have visitors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced 10-day visit to the facility for the complaint received on 6/12/23, and to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted, and granted entry by facility administrator (AD) Celia Rodriguez.

During the investigation, LPA toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed.

It was alleged that staff did not allow resident to have visitors. LPA conducted a total of 9 interviews that consisted of staff and residents. 9 out of the 9 interviews did not corroborate with the allegation, of which two residents stated "I always have visitors". LPA reviewed each resident's visitation log and observed that the facility schedules and documents when a resident has a visitor. During the tour of the facility, LPA observed visitors visiting residents inside the facility.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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-20230612122110

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: LAS ESTANCIAS ASSISTED CARE	FACILITY NUMBER: 306004655
	VISIT DATE: 06/16/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based on LPA’s interviews which were conducted, review of documents obtained, and observations, this allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. For this visit, no citation was issued. An exit interview was conducted with AD Rodriguez. A copy of this report was explained and provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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