306005226-12-13-2023-22-AS-SSAS-CYXU43-20231228141428

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005226
Report Date: 12/13/2023
Date Signed: 12/13/2023 03:46:39 PM

Substantiated

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
09/19/2023 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230919083629

FACILITY NAME:	ARBOR PALMS OF ANAHEIM		FACILITY NUMBER:	306005226
ADMINISTRATOR:	PARK, YOUNG		FACILITY TYPE:	740
ADDRESS:	3411 W BALL RD		TELEPHONE:	(714) 821-9660
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	130	CENSUS: 43	DATE:	12/13/2023
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Darlene Lindley-Administrator		TIME COMPLETED:	03:48 PM

ALLEGATION(S):

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Facility staff did not provide activities for residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced and met with Administrator (Admin) Darlene Lindley for the purpose of delivering the findings into the above allegation. LPA explained the reason for the visit and presented the allegation.

On September 19, 2023, the Department received the complaint. The 10-day investigation was initiated on September 28, 2023, and records were obtained during the visit. Subsequent visits were made on November 8, 2023 and December 7, 2023 to obtain additional records and conduct resident/staff interviews. Additional interviews were also conducted by telephone. The following are the findings of the investigation which involved interviews and file review:

It is alleged that the facility staff did not provide activities for the residents. Per interviews conducted, four out of the seven former/current residents indicated that the weekly outings were not offered under the new management due to an ongoing mechanical issue with their shuttle bus at that point in time.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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-20230919083629

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: ARBOR PALMS OF ANAHEIM	FACILITY NUMBER: 306005226
	VISIT DATE: 12/13/2023

NARRATIVE

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Six out of seven former/current staff also confirmed that the outings were discontinued for approximately two months when the new owners acquired the facility. Although the September 2023 activity calendar noted outings were scheduled every Wednesdays, LPA determined that the facility was not following their planned activities as LPA was informed by four individuals that the weekly visits were initiated again the day LPA visited the facility on November 8, 2023. LPA observed three out of three residents returning from the library outing on November 8, 2023.

Therefore, based on LPA's observations, interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Facility staff did not provide activities for residents is deemed SUBSTANTIATED. The California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D.

An exit interview was conducted with Administrator Darlene Lindley, and a copy of this report including the LIC9099-C, LIC9099-D, and the appeal rights were provided at the end of visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20230919083629

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: ARBOR PALMS OF ANAHEIM	FACILITY NUMBER: 306005226
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/20/2023 Section Cited CCR 87219(a)(2)	1 2 3 4 5 6 7	87219 Planned Activities (a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include: (2) Daily living skills/activities which foster and maintain independent functioning. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The administrator stated that they will ensure residents in care with planned outings pursuant to Regulation and to submit written proof and to provide a signed sign in/out sheet of the residents attending the four subsequent outings to LPA via email by POC due date.
	8 9 10 11 12 13 14	Based on interviews and review of records, the licensee has not provided weekly outings during the period between September to October 2023 which poses a potential Health, Safety, or Personal Rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC9099 (FAS) - (06/04)

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