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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005316
Report Date: 08/15/2024
Date Signed: 08/15/2024 03:44:34 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
05/13/2024 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240513161807
FACILITY NAME:ANAHEIM CROWN PLAZAFACILITY NUMBER:
306005316
ADMINISTRATOR:JOHNSON, CAMMYFACILITY TYPE:
740
ADDRESS:641 SOUTH BEACH BLVDTELEPHONE:
(714) 827-7007
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:200CENSUS: 140DATE:
08/15/2024
UNANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:Michelle Cateron-Administrator Assistant, Gerardo Rodriguez-Facility DesigneeTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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The licensee refused to accept resident back into the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on May 13, 2024. LPA was greeted and granted entry into the facility and met with Administrator Asistant Michelle Cateron and facility designee Gerardo Rodriguez. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that Licensee refused to accept the resident back into the facility. Resident 1 (R1) was admitted to the facility on February 04, 2021. Documents reviewed included the Physician Report (LIC602) dated September 20, 2023 for R1. Per Physician report R1’s diagnosis is Chronic Obstructive Pulmonary Disease (COPD). During the investigation LPA reviewed documents including the Chapman Global Medical Center Discharged paperwork dated May 15, 2024 for Resident 1 (R1). Per Chapman Global Medical Center R1 was admitted to the Hospital on May 01, 2024 due to increased agitation and paranoid. Per Chapman Global Medical Center Discharged paperwork R1 was discharged on May 15, 2024. Per Discharge paperwork R1 to discharge today 05/15/2024 per doctor order to CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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-20240513161807
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: ANAHEIM CROWN PLAZA
FACILITY NUMBER: 306005316
VISIT DATE: 08/15/2024
NARRATIVE
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Skill Nursing Facility (SNF), Anaheim Point Healthcare and Wellness Center. During the course of the interviews Operations Manager (OM) stated that the Licensee did not refused to accept R1 back into the facility. During the course of the interviews with residents, R2 reported that if she needed to go to the Hospital that the Licensee would accept her back into the facility right away and stated that she has not heard about residents not being accepted back into the facility.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to insufficient evidence. Therefore, the allegation has been deemed to be UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with facility representative, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
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