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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004655
Report Date: 10/26/2023
Date Signed: 10/26/2023 03:42:09 PM

Substantiated


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
06/07/2023 and conducted by Evaluator Celine DePerio
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230607152424
FACILITY NAME:LAS ESTANCIAS ASSISTED CAREFACILITY NUMBER:
306004655
ADMINISTRATOR:CELIA RODRIGUEZFACILITY TYPE:
740
ADDRESS:1409 WHITTIER AVENUETELEPHONE:
(714) 488-9995
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:6CENSUS: 5DATE:
10/26/2023
UNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Facility Administrator - Celia RodriguezTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Licensee did not report abuse as mandated.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to the facility to deliver findings for the complaint received on June 7, 2023. LPA arrived at the facility and explained the purpose of today’s visit, was greeted, and granted entry by facility administrator (AD) Celia Rodriguez.

The complaint was investigated by the Department which involved interviews and record review.

It was alleged that licensee did not report abuse as mandated. On August 31, 2023, interviews were conducted with staff and residents at the facility. An interview conducted with AD stated that upon learning about the allegation, AD informed Licensing via phone call, contacted Adult Protective Services (APS), the police, and that the facility conducted their own internal investigation. Per AD, “since I called about it, there was no reason for me to write a report”. Due to APS also being informed about the incident, APS initiated their own investigation. 5 interviews conducted with residents were unable to provide further information regarding this allegation.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
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 5
Control Number 22-AS-20230607152424
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: 10/26/2023
NARRATIVE
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 4 interviews conducted with staff stated that if there was abuse occurring, the facility would have reported it immediately. LPA De Perio conducted reviews of incident reports from the facility, and it was observed that the facility did not submit a written incident report.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, the preponderance of evidence standard has been met, therefore the allegation is SUBSTANTIATED.

An exit interview was conducted with AD Rodriguez.

A copy of this report and appeal rights were provided and explained.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20230607152424
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/02/2023
Section Cited
CCR
87211(a)(1)
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87211 Reporting Requirements
(a) Each licensee shall furnish to the licensing agency such reports...
(1) A written report shall be submitted to the licensing agency...
This requirement is not met as evidence by:
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Licensee will provide a training to all staff regarding the regulation cited, obtain signatures of staff present, and submit proof of understanding to assigned LPA on or by 11/02/2023.
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Based on record reviews, and interviews, facility administrator informed licensing agency regarding the allegation via phone call, however, did not complete and submit a written report.
This poses a potential threat on the health and safety to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
06/07/2023 and conducted by Evaluator Celine DePerio
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230607152424

FACILITY NAME:LAS ESTANCIAS ASSISTED CAREFACILITY NUMBER:
306004655
ADMINISTRATOR:CELIA RODRIGUEZFACILITY TYPE:
740
ADDRESS:1409 WHITTIER AVENUETELEPHONE:
(714) 488-9995
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:6CENSUS: 5DATE:
10/26/2023
UNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Facility Administrator - Celia RodriguezTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Facility staff sexually abused resident
Staff did not contact the police/doctor upon resident request
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to the facility to deliver findings for the complaint received on June 7, 2023. LPA arrived at the facility and explained the purpose of today’s visit, was greeted, and granted entry by facility administrator (AD) Celia Rodriguez.

The complaint was investigated by the Department which involved interviews and record review.

It was alleged that facility staff sexually abused resident. On June 14, 2023, the resident (R1) was interviewed and denied any staff ever making R1 feel unsafe and uncomfortable, and also denied staff ever doing anything to hurt R1. An interview was conducted with facility administrator (AD), who reported that upon learning about the allegation, AD informed R1’s family. The family visits R1 every week and would know if anything had occurred as the R1 would have disclosed it to them. When asked about how R1 liked living at the facility, R1 responded with “I love it” and stated that the staff were good.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20230607152424
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: 10/26/2023
NARRATIVE
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Following that statement, R1 became visibly and verbally agitated and stated, “let me go, let me go”. R1 then refused to answer any more questions, and upon the conclusion of the interview, R1’s demeanor had changed, and was smiling. Per R1’s physician report dated for March 8, 2023, R1 has mild cognitive impairment, is non-ambulatory, is unable to transfer self independently, on and off the bed, and was on hospice. The investigation revealed that R1 never provided any disclosure regarding sexual assault or being hurt by any staff. LPA De Perio interviewed 5 out of 5 residents who confirmed not being hurt or witnessing anyone being hurt. 4 interviews conducted with staff, denied observing any resident being hurt or abused in the facility.

It was alleged that staff did not contact the police/doctor upon resident request. On August 31, 2023, interviews were conducted with staff and residents at the facility. The 5 interviews conducted with residents stated that if needed or requested, the facility contacts 911 upon resident’s request. Resident 1 (R1), resident 2 (R2), resident 3 (R3) and resident 4 (R4) specified that the facility does a “good job” at communicating with each resident’s medical team. 4 interviews conducted with staff stated that the facility contacts the appropriate responders such as police, and 911 regardless if the resident requests it or not and depending on the incident. Staff 1 (S1) specified “we would rather be safe than sorry”.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted with AD Rodriguez.

A copy of this report was provided an explained.

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5