<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005302
Report Date: 12/05/2023
Date Signed: 12/05/2023 11:59:07 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
11/27/2023 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231127140615
FACILITY NAME:MELLS LANE HOMEFACILITY NUMBER:
306005302
ADMINISTRATOR:COLLANTES, DELIA BFACILITY TYPE:
735
ADDRESS:1658 W MELLS LANETELEPHONE:
(657) 230-9766
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:6CENSUS: 3DATE:
12/05/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Dante Benedicto- Assistant Administrator TIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff failed to handle a rodent infestation
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this Day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by Caregiver Carlo Villanueva and explained the reason for the visit. Assistant Administrator Dante Benedicto arrived at 9:44 am.

The Department received a complaint on 11/27/2023 and the initial 10 day visit was conducted on 12/05/2023. During the visit LPA Mendivil toured the facility and interviewed staff. Regarding the allegation facility staff failed to handle a rodent infestation, the investigation revealed the following:

LPA Mendivil toured all client's rooms 2 out of 3 client's rooms were clean with miminal items in the room. In the third client's room Client 1 (C1) LPA Mendivil observed there to be food trash, clothes and shoes on the floor. Per interviews with Assistant Administrator Dante Benedicto, Dante explained that staff has advised C1 to clean their room. CONT on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
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 4
Control Number 22-AS-20231127140615
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: MELLS LANE HOME
FACILITY NUMBER: 306005302
VISIT DATE: 12/05/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on interviews with staff, staff reported that they have not witnessed any rodents in the facility, but that have heard reports from a client that there was at least 1 present. Based on interviews with Assistant Administrator Dante, Dante stated that a pest control company is scheduled to visit the facility on 12/05/2023 to address the rodent issue. During the visit at 11:30 am LPA Mendivil observed Truly Nolen Pest Control to be present in the facility. LPA Mendivil was unable to interview clients as 2 are non verbal and 1 was in day program and not present.

Therefore based on preponderance of evidence through observation and interviews the allegation Facility staff failed to handle a rodent infestation is determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. This agency has investigated this complaint.

No deficiencies cited.

An exit interview was conducted and a copy of this report and confidential list was provided.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4