306005151-2-13-2024-22-AS-LMOA-D3TMT6-20240329095257

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005151
Report Date: 02/13/2024
Date Signed: 02/13/2024 10:47:50 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/22/2020 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200922141127

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: 3	DATE:	02/13/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator, Don Ho		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Facility uses hotplate and microwave in garage for cooking.
Lack of Supervision resulting in Client being aggressive towards other clients and staff
Staff not following menu only offering fast food
Staff verbally abuse to each other in front of clients
Staff and clients not allowed to use kitchen in facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre met with Administrator Don Ho for the purpose of delivering findings for the above allegations. The investigation consisted of Observations, obtained records and interviews with staff and clients.
On 9/22/2020 the department received allegations that facility uses hotplate and microwave in garage for cooking, Lack of supervision resulting in Client being agressive towards other clients & staff, staff not following menu only offering fast food, staff verbally abusive to each other in front of clients and staff & clients not allowed to use kitchen in facility.The investigation was completed by the department and revealed the following:
Based on interviews, three of three staff interviewed stated that facility hotplate and microwave have been placed in garage for storage use and Hot plate have not been used in over a year. During department visit on 10/21/22, LPA observed observed a dusty hotplate on top of barbecue cart. During visit LPA observed staff 1 demonstrate how hotplate is rolled out of the garage on Barbecue cart for use outside of garage.
CONTINUED ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

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-20200922141127

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ANGIE'S HOME	FACILITY NUMBER: 306005151
	VISIT DATE: 02/13/2024

NARRATIVE

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Interviews with both staff and clients revealed that Three of Three clients and three of three staff stated that facility always has caregiver present at all times of the day. Clients confirmed there is one staff per shift for 7 days a week. Clients interviewed stated they are never left alone and there is no current issues with other clients. Clients mentioned in investigation that previously caused disturbances are no longer living at facility.

Interviews also revealed that facility provides meals for clients. Three of three clients interviewed stated that they receive meals from facility daily, Clients indicated that facility accommodates to clients special diets, facility meals are prepared at home and mentioned that clients have a variety of meals provided such as chicken, pasta, fish and hamburgers. Observations from inspection visits revealed that facility has a variety of food from perishables to non-perishables. LPA observed fresh fruits, vegetables, canned soups, dried pastas, bread, dairy milk and eggs. Facility had 72 hour emergency food and water supply during initial visit. LPA observed during visits, clients have containers inside fridge with snacks to clients liking.

Interviews with clients revealed that they have not witnessed staff being verbally abusive with other staff. Interviews with two of three clients revealed staff member and previous client had verbal altercation but that incident occurred once.

Interviews revealed that three of three staff and three of three clients confirmed that clients are allowed to use kitchen microwave and toaster. Interviews also revealed that clients can use stove and are asked to please notify Staff when using stove. During investigation visits LPA observed two clients using kitchen microwave and toaster to prep food items.LPA observed facility house rules state clients can use kitchen to cook but should not leave food unattended.

Based off interviews, documents and observations, the allegations, facility uses hotplate and microwave in garage for cooking, lack of supervision resulting in Client being aggressive towards other clients & staff, staff not following menu only offering fast food, staff verbally abusive to each other in front of clients and staff & clients not allowed to use kitchen in facility are deemed UNSUBSTANTIATED. Although the allegations may have happened or is valid there is no preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted with Administrator and a copy of report was provided to facility.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

LIC9099 (FAS) - (06/04)

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