306005226-3-15-2024-22-AS-AJLO-D3JT8R-20240320143046

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005226
Report Date: 03/15/2024
Date Signed: 03/15/2024 03:43:18 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 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
12/02/2020 and conducted by Evaluator Dwayne L Mason

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201202123042

FACILITY NAME:	ARBOR PALMS OF ANAHEIM		FACILITY NUMBER:	306005226
ADMINISTRATOR:	NANCY RODRIGEZ		FACILITY TYPE:	740
ADDRESS:	3411 W BALL RD		TELEPHONE:	(714) 821-9660
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	130	CENSUS: 48	DATE:	03/15/2024
		UNANNOUNCED	TIME BEGAN:	08:53 AM
MET WITH:	Darlene Lindley - Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Resident sustained unexplained bruises while in care.

INVESTIGATION FINDINGS:

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This unannounced investigation inspection by Licensing Program Analyst (LPA) Dwayne Mason Jr. is being conducted to conclude this agency’s investigation in the complaint allegation(s) mentioned above. LPA arrived at the facility and was greeted by Receptionist Prisca Lee. LPA met with Darlene Lindley, Administrator and Lea Wine, Assistant Administrator and explained the nature of the inspection.

The department received a complaint on 12/02/2020 alleging the resident sustained unexplained bruises while in care. The Reporting Party (RP) disclosed that the resident had severe bruising on their wrists and could not answer questions regarding the cause of the bruising on their wrists. During the investigation, the department interviewed facility staff and the current Administrator of Anaheim Villa (306006387) as the facility Arbor Palms of Anaheim (306005226) underwent a change of ownership in February 2024 and is now closed.

(continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L Mason	TELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024

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-20201202123042

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ARBOR PALMS OF ANAHEIM	FACILITY NUMBER: 306005226
	VISIT DATE: 03/15/2024

NARRATIVE

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(continued from LIC9099)

On 3/15/2024 LPA conducted two separate interviews with Administrator (AD) Darlene Lindley and Assistant Administrator (AAD) Lea Wine regarding the allegation. Lindley and Wine both stated that they started working at the facility after the alleged victim was no longer residing at the facility. Lindley and Wine made no disclosures regarding allegation.

LPA conducted a joint interview with Kitchen Aid (KA) Gina Aba and Memory Care Caregiver (MC) Nancy Macwan. KA and MC stated they did not recall the resident and made no disclosures about the allegation. LPA attempted to interview the Reporting Party (RP) twice by calling the phone number provided on the LIC 802 on 3/15/2024 at 9:40 am and 2:40 pm. LPA was told that the RP no longer works at the company reachable through the provided phone number.

LPA obtained the personnel report (all staff) and resident census. LPA obtained the following documents from the alleged victim’s archived file: Pre-Placement Appraisal, Needs and Services Plan, Physician Reports, hospital admission record (12/8/20), Transfer/Discharge Summary, Post-Discharge Care Plan, Medication Administration Record (December 2020), Narrative Charting (11/2020-2/2021) and death report. LPA obtained the following documents from the files of currently employed staff that were employed by the facility in 2020: Personnel Reports (individual) and Abuse Acknowledgment forms.

Based on interviews conducted, records reviewed and inability to interview Reporting Party or Alleged Victim, there is insufficient evidence that the resident sustained unexplained bruises due to the facility’s negligence. Although the allegation(s) may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted and report was reviewed with Administrator, Darlene Lindley, Assistant Administrator Lea Wine and Receptionist Leslie Rosales. A copy of this LIC-9099 was provided to the facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L Mason	TELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024

LIC9099 (FAS) - (06/04)

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