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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004826
Report Date: 05/22/2024
Date Signed: 05/22/2024 05:07:51 PM

Unsubstantiated


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
05/17/2024 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240517084014
FACILITY NAME:ORANGEWOOD GUEST HOMEFACILITY NUMBER:
306004826
ADMINISTRATOR:MEL CARBAJAL MIN FAJARDOFACILITY TYPE:
740
ADDRESS:1598 W. ORANGEWOOD AVE.TELEPHONE:
(714) 583-8965
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:6CENSUS: 3DATE:
05/22/2024
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Melissa Carbajal - Administrator
Mindy Fajardo - Administrator		TIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility staff did not ensure resident's food was protected against vermin.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to start the investigation for a complaint received May 17, 2024. LPA Haley was greeted by staff and explained the reason for the visit. The complaint investigation consisted of interviews with facility staff, witnesses, and observations made during the complaint visit.

Regarding the allegation: Facility staff did not ensure resident's food was protected against vermin.

3 of 5 individuals interviewed support the complaint allegation above. During an interview with Witness 2 (W2), the witness denied there’s a problem with vermin in the facility and said the facility is always clean. Witness 3 (W3) said the facility is sparkling clean and you can see your reflection on the floor. During the visit, LPA visually inspected the facility, made several observations, and closely examined the cleanliness of the physical plant. During the inspection LPA Haley observed Client 1’s (C1) lunch box, lunch bag(s), and observed how clients’ lunches are prepared and packed. During the inspection several photos were taken.
Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
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
Control Number 22-AS-20240517084014
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ORANGEWOOD GUEST HOME
FACILITY NUMBER: 306004826
VISIT DATE: 05/22/2024
NARRATIVE
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Based on the information gathered during the investigation through interviews and observations, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations is deemed Unsubstantiated.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2