306004761-3-6-2023-22-AS-SHAD-CPP23L-20230306160231

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004761
Report Date: 03/06/2023
Date Signed: 03/06/2023 04:02:38 PM

Document Has Been Signed on 03/06/2023 04:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
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: 65	DATE:	03/06/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Natali Ponce, Lauren Chon		TIME COMPLETED:	04:15 PM

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	This unannounced case management inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of following up a self-reported incident report received in the Orange County Regional Office (OCRO) on 02/23/23 regarding financial issues involving Resident #1 (R1) and Staff #1 (S1). LPA met with Staff #2 (S2) Natali Ponce and discussed the purpose of the inspection. Administrator (AD) Lauren Chon appeared via telephone. The incident report states that: On 02/21/23, the facility learned that R1 had allegedly given $10,000 to S1. AD interviewed R1 who provided conflicting information, at first denying giving money to S1, then claiming they gave S1 $15,000 three years ago which was before R1 moved into the facility. AD also interviewed S1 who stated that R1 had once given them $100 as a gift but that S1 received no additional money from R1. AD tried to interview R1 again but R1 refused to provide more information. AD also spoke with R1’s family who stated that R1 told them about the money they had been giving to S1, but also stated R1 has memory issues. AD also obtained information that R1 had been giving S1 unsolicited love letters which made S1 feel uncomfortable. During today’s inspection, LPA spoke with AD and confirmed the information in the incident report and confirmed AD had no additional information. LPA conducted a health and safety check on R1, confirmed R1 was in good health and good spirits, and interviewed R1. R1 stated they used to give money to staff but stopped doing that years ago. R1 refused multiple times to state whether they had given any money to S1 and, if so, how much money, although R1 did state that S1 needed $12,000 for tuition. R1 denied having any complaints about S1 or the facility. During the interview with R1, LPA determined that R1’s testimony was not reliable. LPA interviewed S1 who stated that R1 had once given them $100 as a gift, but that S1 had received no more money from R1, and that S1 is going to school but the tuition is between $7,000 and $8,000, not $12,000, and S1 is paying the tuition themselves. LPA attempted to review R1’s resident file, but it could not be located at the facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/06/2023

NARRATIVE

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However, AD stated that R1 has psychiatric and memory diagnoses. LPA reviewed S1’s staff file which contained a signed acknowledgement of the facility’s policy that staff are not allowed to accept gifts from residents. LPA did not note any disciplinary issues while reviewing S1’s staff file. LPA confirmed that S1 is background cleared and associated to the facility. AD stated that the facility has an employee policy that staff are not allowed to accept gifts from residents, although there is an anonymous tip jar funding an end-of-the-year gift to employees from residents and their families. AD stated that shortly after 02/21/23, AD retrained all staff on the policy against staff accepting gifts from residents to avoid issues like this in the future. AD stated that S1 has no disciplinary issues, has never been written up, and is a good employee.

Based on the information obtained during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC809 (FAS) - (06/04)

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