306004795-11-17-2020-22-AS-AORZ-BVPNS4-20201125094227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004795
Report Date: 11/17/2020
Date Signed: 11/17/2020 12:03:40 PM

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
07/02/2020 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20200702113636

FACILITY NAME:	WESTMINSTER VILLA		FACILITY NUMBER:	306004795
ADMINISTRATOR:	ANA KUNZ		FACILITY TYPE:	740
ADDRESS:	13881 DAWSON STREET		TELEPHONE:	(714) 534-7880
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92843
CAPACITY:	200	CENSUS: 144	DATE:	11/17/2020
		UNANNOUNCED	TIME BEGAN:	10:26 AM
MET WITH:	Ana Kunz		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Staff are restricting residents from leaving facility

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Kimberly Lyman and Jennifer Tirre made an unannounced complaint visit to deliver findings on the above allegation. LPAs were greeted and granted entry by Administrator Ana Kunz and explained the reason for the visit.
During the course of the investigation, LPAs toured the facility as well as interviewed staff and witnesses. Regarding the allegation that staff are restricting residents from leaving facility, the investigation revealed the following: LPAs interviewed ten residents, four staff and Ombudsman. All denied residents are being restricted from leaving the facility. Ten out of ten residents state they are able to leave the facility without restrictions. Facility staff state only advising residents to take precautions when leaving the facility. Therefore the allegation is deemed UNFOUNDED, meaning the allegation was false, could not have happened and/or is without a reasonable basis.
A copy of this report was left at the facility.

Unfounded

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: 11/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2020

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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