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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005226
Report Date: 11/08/2023
Date Signed: 11/08/2023 03:57:57 PM

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
11/06/2023 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231106150655
FACILITY NAME:ARBOR PALMS OF ANAHEIMFACILITY NUMBER:
306005226
ADMINISTRATOR:YOUNG PARKFACILITY TYPE:
740
ADDRESS:3411 W BALL RDTELEPHONE:
(714) 821-9660
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:130CENSUS: 52DATE:
11/08/2023
UNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Darlene Lindley-Executive Director, Lea Wine-Administrator AssistantTIME COMPLETED:
04:08 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Executive Director (ED) Darlene Lindley. LPA explained the reason for the visit.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: One of nine individuals interviewed corroborated the allegation. Seven of nine individuals interviewed denied the allegation and the remaining individual could not be qualified to answer questions. During the initial visit on 11/08/23 LPA observed that there were three caregivers working in the Memory Care Unit for 24 residents in care. During the investigation LPA reviewed documents including the staff schedule for October and November 2023. Per staff schedule on average there are two Caregivers and two Medication Technicians for the morning and evening shifts,
CONTINUED 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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 5
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
11/06/2023 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231106150655

FACILITY NAME:ARBOR PALMS OF ANAHEIMFACILITY NUMBER:
306005226
ADMINISTRATOR:YOUNG PARKFACILITY TYPE:
740
ADDRESS:3411 W BALL RDTELEPHONE:
(714) 821-9660
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:130CENSUS: 53DATE:
11/08/2023
UNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Darlene Lindley-Executive Director, Lea Wine-Administrator AssistantTIME COMPLETED:
04:08 PM
ALLEGATION(S):
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9
Facility does not have a complaint poster posted at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Executive Director (ED) Darlene Lindley. LPA explained the reason for the visit.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Eight of nine individuals interviewed corroborated the allegation. During the initial visit on 11/08/23 LPA observed that there is no complaint poster posted at the main entryway of the facility. During the interviews conducted with residents, it was reported by Resident 1 (R1) that they have only seen the Ombudsman complaint sign posted in the hallway. During the interviews conducted with staff, Staff 1 (S1) reported that they have only seen the complaint poster in the Medication Room.
CONTINUED ON 9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20231106150655
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: ARBOR PALMS OF ANAHEIM
FACILITY NUMBER: 306005226
VISIT DATE: 11/08/2023
NARRATIVE
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During the course of the interviews ED stated that she has not seen the complaint poster posted in main entrance.

Based on the interviews which were conducted and LPA observations, the preponderance of evidence standard has been met, therefore the following allegation: facility does not have a complaint poster posted at the facility is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D.

An exit interview was conducted with ED Lindley and a copy of this report along with the Appeal Rights were provided at the time of this visit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20231106150655
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: ARBOR PALMS OF ANAHEIM
FACILITY NUMBER: 306005226
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2023
Section Cited
CCR
87468(c)(2)(A)
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Personal Rights (c)Licensees shall prominently post....complaint information in areas accessible to residents, representatives, and the public. (2)...procedures for filing confidential complaints, shall be posted as follows: (A)The poster that is posted shall be
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Per ED the complaint poster will be printed and posted in the main entrance. ED to email LPA proof of the complaint poster posted by POC due date.
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20" x 26" in size and be posted in the main entryway of the facility. This requirement is not met as evidence by: Per interviews conducted and LPA observations there is no complaint poster posted at the entryway of the facility. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20231106150655
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: ARBOR PALMS OF ANAHEIM
FACILITY NUMBER: 306005226
VISIT DATE: 11/08/2023
NARRATIVE
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 and one Caregiver and one Medication Technician for the night shift in Assisted Living for 28 residents in care. Per staff schedule there are three Caregivers and two Medication Technicians for the morning and evening shifts and one Caregiver and one Medication Technician for the night shift in Memory Care for 24 residents in care. During the course of the interviews ED stated that the facility had a lot of staff that would call out sick but that the facility has hired new staff that are reliable. Per ED herself, the Administrator Assistant and agency staff will cover shifts when caregivers do not come to work. During interviews conducted with staff, Staff 1 (S1) reported that caregivers try their best to provide good care and supervision and that they have not seen only one Caregiver working at Memory Care.

Based on LPA's observation and information gathered during the investigation, 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, the allegation is deemed UNSUBSTANTIATED.

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

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5