306004795-1-18-2024-22-AS-SSAS-CZYUEV-20240130143146

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004795
Report Date: 01/18/2024
Date Signed: 01/18/2024 04:51:07 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
01/17/2024 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240117145341

FACILITY NAME:	WESTMINSTER VILLA		FACILITY NUMBER:	306004795
ADMINISTRATOR:	PATTY OSUNA		FACILITY TYPE:	740
ADDRESS:	13881 DAWSON STREET		TELEPHONE:	(714) 534-7880
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92843
CAPACITY:	200	CENSUS: 123	DATE:	01/18/2024
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Patty Osuna, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not ensure hot water is available to residents

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the allegation listed above. LPA was greeted and granted entry by front desk staff after introducing himself and stating the purpose of the visit. Administrator Patty Osuna was present to assist the visit and was explained the allegation investigated.

LPA conducted an interview with facility administrator who explained that there were known issues with one of the two water heaters in use by the facility. The part needed to make the necessary repairs is stated to have been ordered at this time, but was stated by the vendor to be back-ordered by approximately two weeks.

LPA accompanied by facility staff conducted a tour of the physical plant and measured water temperatures in a sample of 18 rooms across the two levels. A total of twelve rooms among these were observed to have no hot water whatsoever at the time of the visit.
CONTINUED ON FORM LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

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-20240117145341

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WESTMINSTER VILLA	FACILITY NUMBER: 306004795
	VISIT DATE: 01/18/2024

NARRATIVE

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CONTINUED FROM FORM LIC9099
Additionally, seven resident interviews were either conducted or attempted during the tour of the units where hot water temperatures were reviewed. All the residents interviewed confirmed that there had been issues with the hot water approximately since the beginning of the week, on or around January 15, 2024.

Regarding the allegation that "Staff do not ensure hot water is available to residents", the following has been concluded: Based on interviews conducted and a tour of the facility's physical plant, it was determined that a significant number of units and residents had no running hot water in the bathroom sinks used for grooming and in the shower. Facility staff states that some residents with no hot water were offered to shower in vacant units with hot water access but adds that many declined. As a result, the allegation is found to be Substantiated, meaning that the preponderance of evidence standard has been met. A Type B citation is issued on the attached form LIC9099-D.

An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20240117145341

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WESTMINSTER VILLA	FACILITY NUMBER: 306004795
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/18/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/01/2024 Section Cited CCR 87303(e)(2)	1 2 3 4 5 6 7	Per the California Code of Regulations Section 87303(e)(2) "Faucets used by residents for personal care such as shaving and grooming shall deliver hot water." This requirement is not met as evidenced by: Based on observation and interviews conducted at the facility, an unspecified	1 2 3 4 5 6 7	Licensee has already initiated action to repair the facility's dysfunctional water heater and will confirm that the required repairs have been conducted and hot water service been restored before the plan of correction due date.
	8 9 10 11 12 13 14	number of units are confirmed to have no access to hot water or limited intermittent access based on the use made in other parts of the facility. This constitutes a potential risk to the health, safety and personal risks of individuals in care.	8 9 10 11 12 13 14
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC9099 (FAS) - (06/04)

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