306004807-1-13-2023-22-AS-LADS-CNSTYF-20230206140838

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004807
Report Date: 01/13/2023
Date Signed: 01/13/2023 02:44:01 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
12/31/2020 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201231114210

FACILITY NAME:	LINA'S BOARD AND CARE		FACILITY NUMBER:	306004807
ADMINISTRATOR:	CRYSTAL LARA		FACILITY TYPE:	735
ADDRESS:	1511 E. STAFFORD STREET		TELEPHONE:	(714) 558-6007
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92701
CAPACITY:	6	CENSUS: 4	DATE:	01/13/2023
		UNANNOUNCED	TIME BEGAN:	01:44 PM
MET WITH:	Administrator, Crystal Lara		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff pushed client on the back

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On this day Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to deliver findings on complaint investigation. LPA was granted entry by staff. LPA discussed purpose of the visit with Administrator Crystle Lara.
During the course of this investigation LPA conducted interviews with staff and clients, observations of clients in care and a review of client records was completed, Copies of pertinent documents obtained.
It is alleged that staff pushed client on back. Based on conflicting information received from interviews, the lack of information regarding the incident in question, and the lack of corroborating witness to the incident, LPA is unable to determine if the alleged violation occurred as reported.

We have found the complaint allegation is UNSUBSTANTIATED, although the allegation may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violation occurred as reported.

This report is being reviewed with administrator and a copy of this report was left at the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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

LIC9099 (FAS) - (06/04)

Page: 1 of 2