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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005302
Report Date: 02/22/2024
Date Signed: 02/22/2024 10:48:53 AM

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
12/04/2023 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231204113932
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:
02/22/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Delia Collantes - AdministratorTIME COMPLETED:
10:14 AM
ALLEGATION(S):
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Facility did not properly manage client's Social Security/P&I funds
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to deliver the findings on the complaint allegation above. LPA Haley was greeted by staff and explained the reason for the visit.

Regarding the allegation: Facility did not properly manage client's Social Security/P&I funds.
During the investigation interviews were conducted with the client, witnesses, and facility staff, including interviews with the Administrator, and the Assistant Administrator. 4 of 5 interviews confirmed several checks for C1 have went uncashed, resulting in the client going over their resource limit resulting in the client's benefits being reduced to $0.00. In addition to interviews, emails and documents were reviewed during the investigation.

During an interview with a witness, it was discovered the Administrator was not responsive in regard to several checks that went uncashed. An additional email the was sent September 14, 2023 to the Administrator,and Assistant Administrator informing them the clients benefits have been reduced to $0.00.
Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
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 3
Control Number 22-AS-20231204113932
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: 02/22/2024
NARRATIVE
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A Social Security Administration document review revealed C1’s Social Security Benefits were reduced to $0.00 as of October 1, 2023.

A review of emails provided from a witness dated: February 9, 2023, March 9, 2023, and April 10, 2023, sent to the facility Administrator and Assistant Administrator never received a response from the Administrator. The Assistant Administrator responded but never directly answered the questions being asked or provided the information requested in the emails regarding the status of uncashed checks and a request for clients’ needs and wants.

Review of an email forwarded by the Administrator dated December 7, 2023 show the email address matched the email address used by the witness to send emails about the checks that went uncashed, a request to find out the client’s needs and wants for the client’s room, and the email about the client’s benefits being reduced to $0.00. It is unclear why the Administrator never responded, and the Assistant Administrator could not provide answers to the questions being asked in the emails.

During interviews with the Administrator and Assistant Administrator, both admitted there is no P&I ledger for C1 because the client manages their own money. A review of the clients IPP with a meeting date of November 21, 2022 indicate C1’s funds will be disbursed to the home.

Based on the evidence gathered during interviews and document review, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22, Division 6.

An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20231204113932
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/29/2024
Section Cited
CCR
80026(b)
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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents
(b) If such a client is accepted for or maintained in care, his/her cash resources, personal property, and valuables... shall be handled by the licensee or facility staff and shall be safeguarded in accordance with the requirements specified in (c) through (n) below.
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Administrator Collentes agrees to send a detailed plan of action that outlines steps to be taken to prevent checks from being uncashed and a clients benefits being reduced in the future. Administrator Collantes will email the plan to LPA Haley by Thursday, February 29, 2024 at 1:00PM.
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This requirement has not been met as evidenced by the clients Social Security benefits being reduced to 0.00 due to uncashed checks sent to the facility.
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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.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3