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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306004795
Report Date:
07/02/2021
Date Signed:
07/02/2021 12:38:21 PM
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:
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:
130
DATE:
07/02/2021
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
08:20 AM
MET WITH:
Ana Kunz and Patty Osuna
TIME COMPLETED:
08:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced case management visit to follow up on an incident report submitted to Community Care Licensing (CCL) on 06/23/2021. LPA met with Chief Executive Officer (CEO) Ana Kunz and explained the reason for the visit. Administrator Patty Osuna and Ombudsman Lan Tran were present as well.
Incident report dated 06/23/2021 indicated Resident 1 (R1) reported $1400 was stolen from the resident's room. Facility conducted their own investigation as well as filed a police report. LPA interviewed R1 through Ombudsman Tran due to language incompatibilities. R1 stated that the money was kept in a paper towel in the resident's pillow case and nobody was aware of the money. LPA interviewed staff that was working on the day in question and the allegation was denied. Facility to change process in which P & I money is delivered to residents to avoid any incidents in the future.
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:
07/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/02/2021
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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