306005211-1-30-2024-22-AS-MSTC-D225W5-20240131191835

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005211
Report Date: 01/30/2024
Date Signed: 01/30/2024 11:49:42 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
09/30/2020 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200930151047

FACILITY NAME:	ARDENT CARE		FACILITY NUMBER:	306005211
ADMINISTRATOR:	MELINDA FLORES		FACILITY TYPE:	740
ADDRESS:	1665 SOUTH BROOKHURST STREET		TELEPHONE:	(714) 991-0991
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	27	CENSUS: 21	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	08:59 AM
MET WITH:	Melinda Flores-Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident sustained a fall due to lack of supervision.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on 09/30/20. LPA was greeted and granted entry into the facility by Medication Technician (MT) Fabiola Fuentes. LPA explained the reason for the visit.

Per Tittle 22, Section 87506 Resident Records under (e) Original records or photographic reproductions shall be retained for a minimum of three (3) years. Due to the complaint being over three years LPA was unable to review Resident 1 (R1) records.

This agency has investigated the complaint alleging that Resident sustained a fall due to lack of supervision. Regarding the allegation, the following was revealed: One of five individuals interviewed confirmed the allegation. During interviews conducted with residents, R1 reported that staff are helpful and stated that he has not had a fall due to lack of supervision. During the interviews Administrator (AD) stated that
CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 22-AS-20200930151047

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: ARDENT CARE	FACILITY NUMBER: 306005211
	VISIT DATE: 01/30/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

R1 had a change in condition and became wheelchair bounded. Per AD R1 did not have a fall due to lack of supervision. During the investigation LPA reviewed documents including the staff schedule dated January 2024. Per staff schedule on average there is one medication technician and two caregivers for the morning and evening shifts and one medication technician and one caregiver for the night shift for 21 residents in care.

Based on the information gathered during the investigation, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Therefore, the allegation has been deemed to be UNSUBSTANTIATED, meaning 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.

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

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2