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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004839
Report Date: 12/11/2023
Date Signed: 12/11/2023 11:24:50 AM

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
09/23/2020 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20200923110812
FACILITY NAME:FULLERTON VILLAFACILITY NUMBER:
306004839
ADMINISTRATOR:DARLENE LINDLEYFACILITY TYPE:
740
ADDRESS:2441 W. ORANGETHORPE AVE.TELEPHONE:
(714) 992-5380
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:197CENSUS: 174DATE:
12/11/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Darlene LindleyTIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not giving resident PRN medication.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to continue the investigation into the allegation listed above. LPA met with Administrator Darlene Lindley. LPA explained the reason for the visit. LPA reviewed facility records for Resident 1 (R1). LPA and Administrator toured the facility. The investigation revealed the following. Facility records for R1 show R1 was prescribed Hydrocodone-Acetamin 5-325 MG as needed (for pain) and Lorazepam .5 MG as needed (PRN medications). It was reported that on 9/22/2020 the facility did not provide R1 with their PRN Hydrocodone-Acetamin when requested by R1. Facility records show that R1's health care provider sent the facility orders on 9/22/2020 and 9/24/2020 to hold their PRN Hydrocodone-Acetamin till further orders are provided. The Administrator reported that R1 was made aware of the orders by their healthcare provider and by facility staff. R1 no longer resides at the facility and their where abouts are unknown. There is no current contact information for R1. R1 could not be reached for interview. Based on the evidence gathered the allegation is deemed unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of the report provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023
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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