306004839-12-13-2023-22-AS-SSAS-CYXSU9-20231228131048

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004839
Report Date: 12/13/2023
Date Signed: 12/13/2023 12:52:57 PM

Unfounded

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
12/04/2020 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201204161940

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: 173	DATE:	12/13/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Darlene Lindley- Administrator		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility is not following resident's admission agreement.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose to investigate into the above allegation. LPA met with Administrator (Admin) Darlene Lindley, explained the reason for the visit, and discussed the elements of the allegation.

On December 4, 2020, the Department received the complaint, and the 10-day investigation was initiated by LPA Lydia Martinez. LPA Martinez conducted the investigation via telephone and obtained the records via email due to the Coronavirus 2019 precautionary measures at that point in time. During today's visit, LPA Jessica Cho obtained addtional resident records and interviewed resident/staff. The following was revealed during the course of the investigation pertaining to Resident #1 (R1):

It is alleged that the facility is not following the resident's admission agreement. In review of the parking fee notice dated November 10, 2020, the notice indicates effective December 10, 2020, there would be a fee of $100.00 for residents utilizing the parking lot.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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-20201204161940

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: 12/13/2023

NARRATIVE

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The parking fee however was waived as noted on the letter sent to R1 on December 10, 2020. In the statements from R1 and Staff #1 (S1), both confirmed that the parking fee was waived and the issue was resolved. It is determined that the facility adhered to the admission agreement by not imposing the parking fee.

Therefore, this agency has investigated the complaint and based on the interviews which were conducted and the records that were reviewed, the following allegation: Facility is not following the resident's admission agreement is deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Administrator Darlene Lindley, and a copy of this report and the LIC811s were provided at the end of the visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC9099 (FAS) - (06/04)

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