306004761-8-16-2023-22-AS-AORZ-CYFN63-20231212091025

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004761
Report Date: 08/16/2023
Date Signed: 08/16/2023 03:24:20 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
08/08/2023 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230808165111

FACILITY NAME:	CAMBRIDGE COURT		FACILITY NUMBER:	306004761
ADMINISTRATOR:	LAUREN CHON		FACILITY TYPE:	740
ADDRESS:	1621 COMMONWEALTH AVENUE, EAST		TELEPHONE:	(714) 992-1750
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92831
CAPACITY:	99	CENSUS: 69	DATE:	08/16/2023
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Lupe Jaime, Purchasing Director/House Keeping Supervisor and Lauren Chon, Administrator		TIME COMPLETED:	03:23 PM

ALLEGATION(S):

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-Facility staff serving food that is not of quality.

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz made an unannounced visit for the purpose to conduct a 10 day inspection visit for complaint allegation listed above. LPA Quiroz was greeted and met with Lupe Jaime, Purchasing Director/House Keeping Supervisor (PD/HS) and discussed purpose of today's visit. Administrator (AD) Lauren Chon arrived during today's visit.
Regarding the allegation "Facility staff serving food that is not of quality," the investigation revealed the following: During today's visit while conducting 10 day visit, LPA Quiroz conducted tour along with (PD/HS) Lupe Jaime, but not limited to: kitchen area and diningroom area . During today's visit, on or about 11:10am LPA Quiroz observed lunch being served consisting of Kung pao chicken, chow mein, cabagge, turnover for desert, water, juice, tea, coffee and milk as beverage option.
During today's visit, LPA Quiroz reviewed facility menu dated July 13-August 19, 2023 and resident records for Resident 1- Resident 12. LPA Quiroz reviewed menu with sixteeen interviewees consisting of staff and residents. sixteen of sixteen interviewees indicating food is palpatable, of variety, good quality indicating facility follows menu. CONTINUED NEXT PAGE...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

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-20230808165111

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: CAMBRIDGE COURT	FACILITY NUMBER: 306004761
	VISIT DATE: 08/16/2023

NARRATIVE

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CONTINUED...Sixteen of sixteen interviewees indicated a substitute meal is always readily available if requested by the resident.

Therefore based on the preponderance of evidence gathered through interviews and observations conducted by LPA Quiroz on 8/16/2023, the allegation that the "Facility staff serving food that is not of quality" is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint.

No deficiencies cited during today's visit.

An exit interview was conducted with Administrator Lauren Chon and a copy of today's report was provided.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

LIC9099 (FAS) - (06/04)

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