306005260-5-29-2024-22-AS-LMOA-D5SRQ6-20240531131301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005260
Report Date: 05/29/2024
Date Signed: 05/29/2024 04:55:29 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
12/08/2021 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211208162350

FACILITY NAME:	COAST SENIOR CARE		FACILITY NUMBER:	306005260
ADMINISTRATOR:	VIANA, KRISTEN		FACILITY TYPE:	740
ADDRESS:	22201 CAPE MAY LANE		TELEPHONE:	(714) 377-0638
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92646
CAPACITY:	0	CENSUS: 5	DATE:	05/29/2024
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Caregiver Reynoldo Avena		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff physically abused client

INVESTIGATION FINDINGS:

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On this day Licensing Program Analysts (LPA)'s Jenifer Tirre and Jessica Cho made an unannounced Collateral Joint visit to Coast Senior Care 1 located at 19861 Carmania lane in Huntington Beach to follow up on complaint investigation control number 22-AS-20211208162350. LPA's discussed purpose of the visit and allegations with Caregiver.

The Investigation consisted of obtained records, staff interviews, resident interviews and observations. On 12/08/2021, the Department received allegations Staff physically abused client. The Investigation was completed by the department and revealed the following: based on record review facility documents revealed facility staff have Criminal background clearance and caregiver training. Resident Records revealed Resident 1 (R1) had a diagnosis of Unspecified Focal Traumatic Brain Injury and depression. Interviews with staff revealed that three of three staff interviewed confirmed they have never witnessed any physical abuse to the residents in care by other staff members.
CONTINUED ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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-20211208162350

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: COAST SENIOR CARE	FACILITY NUMBER: 306005260
	VISIT DATE: 05/29/2024

NARRATIVE

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Staff interviews revealed that staff treat residents with care as they would to their own family members.

Resident interviews revealed that Five of Five residents denied that staff have ever hit or touched them inappropriately. Five of five residents confirmed that there is no issues regarding care being provided by staff. Five of Five residents confirmed that their needs are being met by facility. Interviews with witness confirm that R1 was very lucid during last visit and remembers times when they were back in the military. Witness interview confirms that R1 informed them they could not recall times or days of incidents of alleged abuse. Witness interview revealed that R1 was isolated to themselves and depressed. During initial visit, LPA made observations of residents relaxing in common areas and resting inside bedrooms. During visit LPA did not observe any physical bruising or marks on any of the residents skin.

Based on information gathered, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted with Administrator via telephone and copy of this report was left at facility.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

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