306005211-12-6-2023-22-AS-SSAS-CYF48A-20231211175225

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005211
Report Date: 12/06/2023
Date Signed: 12/06/2023 09:15:03 AM

Unsubstantiated

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
11/03/2023 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231103104532

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: 22	DATE:	12/06/2023
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Fabiola Fuentes Melinda Olivarez - Administrator		TIME COMPLETED:	08:45 AM

ALLEGATION(S):

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Resident sustained an injury from lack of supervision.

INVESTIGATION FINDINGS:

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LPA Haley made an unannounced visit to deliver the findings on the complaint allegation above. LPA Haley was greeted by staff and explained the reason for the visit.

Regarding the allegation: Resident sustained an injury from lack of supervision.

During the investigation 7 interviews were conducted with facility staff, the resident involved, and a family member of the resident involved. None of the 7 individuals interviewed were able to support the complaint allegation as reported. During the investigation, it was discovered Resident 1 did have a fall in the middle of the night and was sent to the hospital for a head injury. All staff members interviewed, including the Administrator confirmed there were two employees working when R1 had an unwitnessed fall in her room around 3:00AM. During an interview with a family member of R1, it was discovered the family member was notified right away and went to the ER with R1. The family member had no problem with how the caregivers responded to the situation, “They (staff) responded correctly as far as I can tell.”
Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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-20231103104532

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: ARDENT CARE	FACILITY NUMBER: 306005211
	VISIT DATE: 12/06/2023

NARRATIVE

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During an interview with Resident 1 (R1) who suffered the unwitnessed fall, acknowledged falling down and sustaining an injury trying to walk, but did not know how the fall occurred.

Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, all allegation is deemed Unsubstantiated.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

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