306004839-12-12-2023-22-AS-SSAS-CYXSP7-20231228130238

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004839
Report Date: 12/12/2023
Date Signed: 12/12/2023 02:26:24 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
08/14/2020 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200814090028

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: 174	DATE:	12/12/2023
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Darlene Lindley - Administrator		TIME COMPLETED:	01:59 PM

ALLEGATION(S):

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Facility did not prevent the spread of scabies

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to investigate the complaint allegation above. LPA Haley identified himself and explained the reason for the visit with staff. During the visit, staff lead a brief tour of the facility before interviews began.

Regarding the allegation: Facility did not prevent the spread of scabies

During the investigation, interviews were conducted with Administrator Darlene Lindley, staff members and residents. 5 individuals interviewed confirmed residents had scabies. 4 staff members interviewed confirmed residents had scabies in 2020. Staff 1 (S1) stated the scabies were treated right away. S1 claimed the facilities in house doctor prescribed cream to treat the residents who had scabies and their roommate, even if the roommate did not have scabies they were still treated. Staff 2 (S2) confirmed residents had scabies and said residents were treated with cream, isolated, rooms were sanitized, and cloths were separated and cleaned.
Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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-20200814090028

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: 12/12/2023

NARRATIVE

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Staff 3 (S3) confirmed the outbreak and said it lasted about two or three weeks. During interviews with S3 and S4, they both said they were pleased with how the facility handled the scabies outbreak. S3 said, “Once they found out, they immediately sanitized the room, separated the residents, and they didn’t allow contact with other residents.” Residents 1 (R1) confirmed they had scabies. R1 claims they were itching really bad and said it was unbearable. R1 claims a former manger at the facility helped the resident get better. Other residents interviewed said they did not have scabies, and both claimed they were not aware anyone had scabies during that time.

Based on the evidence gathered through interviews, and document review, 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 violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

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