306005151-4-21-2023-22-AS-AORZ-CRJMYT-20230505100200

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005151
Report Date: 04/21/2023
Date Signed: 04/21/2023 11:04:46 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
10/12/2020 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201012170159

FACILITY NAME:	ANGIE'S HOME		FACILITY NUMBER:	306005151
ADMINISTRATOR:	HO, DUNG VAN		FACILITY TYPE:	735
ADDRESS:	1401 S JEFFERSON AVE		TELEPHONE:	(714) 733-9552
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92832
CAPACITY:	6	CENSUS: 2	DATE:	04/21/2023
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Dung Van Ho-Administrator		TIME COMPLETED:	11:19 AM

ALLEGATION(S):

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Client being bullied by another client (hit, things thrown at him and called names)

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on 10/12/20. LPA was greeted and granted entry into the facility and met with Administrator (AD) Dung Van Ho. LPA explained the reason for the visit.

This agency has investigated the complaint alleging that client is being bullied by another client. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: One of three individuals interviewed reported that both clients would joke around like family. It was reported via interviews that Client 2 (C2) would joke around and point fingers closely to C1’s face. One of three individuals interviewed corroborated the allegation. During the investigation LPA reviewed included the House Rules signed by both C1 and C2. Per House Rule number four “No hitting, kicking or verbal assaults toward any house member.” During the course of the interviews AD stated that he encouraged the clients to respect each other.
CONTINUED on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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-20201012170159

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ANGIE'S HOME	FACILITY NUMBER: 306005151
	VISIT DATE: 04/21/2023

NARRATIVE

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During the follow up visit on 04/14/23 and today’s visit LPA observed that C1 and C2 are no longer residing at the facility. LPA Ramirez was unable to locate and therefore unable to conduct interviews as C1 has a telephone number that is disconnected and C2 is currently living back at home with their mother. During the follow up visit on 04/14/23 and today’s visit clients appeared to be comfortable and at ease as evidence by smiling, laughing and by conversating with staff.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with AD Ho, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC9099 (FAS) - (06/04)

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