306004761-4-23-2024-22-AS-AORZ-D4STXC-20240429150652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004761
Report Date: 04/23/2024
Date Signed: 04/23/2024 11:49:33 AM

Unsubstantiated

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
11/02/2020 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20201102151301

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: 73	DATE:	04/23/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Lupe Jaime		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Staff are not providing adequate food service
Staff are not providing activities for residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to continue the investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility and interviewed staff and residents. LPA reviewed and obtained pertinent documentation such as food menu and activity schedule. Regarding the allegations that staff are not providing activities for residents and staff are not providing adequate food service, the investigation revealed the following: Four out of four residents admitted at the facility in 2020 confirm appropriate food delivery to rooms during the covid lockdown. All four state no issues with the food being warm. LPA toured the kitchen during the investigation and observed insulated food delivery boxes utilized for delivery. Three out of three staff state food deliveries occurred right after plating the containers and were delivered in the insulated boxes. All three state no complaints received from residents regarding the temperature of food. Four out of four residents state the facility provided Bingo in the facility hallways as well as games and puzzles in the resident rooms during the lockdown. CONT ON LIC 9099C DATED 4/23/24

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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-20201102151301

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: 04/23/2024

NARRATIVE

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LPA observed current activity schedule which includes activities throughout the day including music therapy, Bingo, and exercise. Facility supervisor indicates rate increases are given annually and no rate increase occurred due to covid. Based on interviews conducted, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conducted and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

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