306004839-4-28-2021-22-AS-VCOK-C3LSSM-20210602140809

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004839
Report Date: 04/28/2021
Date Signed: 04/28/2021 11:41:25 AM

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
07/06/2020 and conducted by Evaluator Lydia Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200706145154

FACILITY NAME:	FULLERTON VILLA		FACILITY NUMBER:	306004839
ADMINISTRATOR:	DARLENE LINDLEY		FACILITY TYPE:	740
ADDRESS:	2441 W. ORANGETHORPE AVE.		TELEPHONE:	(714) 992-5380
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92833
CAPACITY:	197	CENSUS: 121	DATE:	04/28/2021
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Darlene Lindley		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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* Unlawful Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lydia Martinez contacted the facility to deliver findings on the above complaint investigation via telephone due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call and elements of allegation with Administrator Darlene Lindley.

LPA Martinez conducted interviews with staff, resident, and a witness. During the course of the investigation the following was revealed: LPA Martinez reviewed Facility's COVID-19 Shelter in Place Policy, Warning to R1 dated 3/16/2021, and R1's Physician Report. All individuals interviewed, including R1, corroborated that the facility did not issue an eviction notice to R1.

Administrator stated that in March 2020, she placed a copy of Facility’s COVID-19 Shelter in Place Policy in R1’s room as a reminder due to R1 leaving the building during the day. Administrator also stated they might have mentioned to issue a 30-day notice if R1 did not follow the Policy but instead gave R1 a Warning. Administrator stated the Health and Safety of the residents was her priority during the Pandemic.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

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-20200706145154

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: FULLERTON VILLA	FACILITY NUMBER: 306004839
	VISIT DATE: 04/28/2021

NARRATIVE

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LPA Martinez interviewed R1, who reported she did not receive an Eviction Notice but was told to follow the rules on the paper left in her room. This was corroborated by a close source who reiterated R1 was not served with an Eviction Notice but it was mentioned to her.

Based on the evidence gathered from interviews and a review of pertinent documentation, allegation of "Unlawful Eviction" is deemed Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Therefore complaint is dismissed.

An exit interview was conducted, and a copy of this report was provided via email along with LIC 811- Confidential Names list. Administrator Lindley agreed to sign and email a copy of report back to LPA.

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

LIC9099 (FAS) - (06/04)

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