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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004795
Report Date: 03/02/2023
Date Signed: 03/02/2023 10:50:14 AM

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
02/22/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230222084528
FACILITY NAME:WESTMINSTER VILLAFACILITY NUMBER:
306004795
ADMINISTRATOR:PATTY OSUNAFACILITY TYPE:
740
ADDRESS:13881 DAWSON STREETTELEPHONE:
(714) 534-7880
CITY:GARDEN GROVESTATE: CAZIP CODE:
92843
CAPACITY:200CENSUS: 119DATE:
03/02/2023
UNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Patty OsunaTIME COMPLETED:
11:05 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff allowed resident to leave the facility unsupervised.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Administrator Patty Osuna. LPA explained the reason for the visit. The investigation into the allegation, staff allowed resident to leave the facility unsupervised revealed the following. It was alleged that Resident 1 (R1) left the facility unsupervised on 2/16/23 around 1:15 pm and was found walking in the street around a quarter of a mile away. It was reported that R1 was disoriented and confused and then brought back to the facility by concerned citizens. R1 verified they were brought back to the facility and reported they were not disoriented or confused. R1 reported that someone offered them a ride home so they accepted. A review of R1's physician report shows that R1 is able to leave the facility unassisted. Staff interviewed reported that R1 leaves the facility each day and returns in the afternoon. Based on the evidence gathered the allegation, staff allowed resident to leave the facility unsupervised is deemed unfounded, meaning the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview was conducted and a copy of this report was provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
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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