306005333-2-24-2023-22-AS-SSAS-CPH4NB-20230228181451

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005333
Report Date: 02/24/2023
Date Signed: 02/24/2023 11:36:39 AM

Unfounded

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
02/15/2023 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230215102915

FACILITY NAME:	ORANGE HILL ELDERLY CARE		FACILITY NUMBER:	306005333
ADMINISTRATOR:	RODRIGUEZ, FRANCIS		FACILITY TYPE:	740
ADDRESS:	2586 N ORANGE HILL RD		TELEPHONE:	(714) 602-6072
CITY:	ORANGE	STATE: CA	ZIP CODE:	92867
CAPACITY:	6	CENSUS: 6	DATE:	02/24/2023
		UNANNOUNCED	TIME BEGAN:	11:02 AM
MET WITH:	Glenn Navarro, Lead Staff		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Staff did not maintain the kitchen in a clean and sanitary condition.
Staff administered medication resident did not need.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit to deliver the findings into the above allegations. LPA Cho met with Lead Staff Glenn Navarro and Caregiver Bordy Navarro and stated the purpose of this visit. LPA presented the findings to Staff Glen who is the designated person to sign the report as indicated per the Designation of Facility Responsibility (LIC308) received on February 22, 2023. Staff Navarro notified Administrator (Admin) Jennifer Brower by a text message sent at 11:11am.

During the course of the investigation, LPA obtained and reviewed pertinent resident records and conducted interviews with residents, staff, and Administrator. The following are the findings which involved observations, record review, and interviews: On the allegation that staff did not maintain the kitchen in a clean and sanitary condition, it was alleged that the facility took 2 weeks to clean the smoke dust particles from the recent fire that occurred approximately 4:00 pm on January 20, 2023. Per record review, LPA Joseph Alejandre conducted a case management visit the day the fire occurred at 6:22pm.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

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-20230215102915

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: ORANGE HILL ELDERLY CARE	FACILITY NUMBER: 306005333
	VISIT DATE: 02/24/2023

NARRATIVE

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The report indicated that the facility was clean, room temperature measured at 73 degrees Fahrenheit, and health and safety concerns were not observed.

On the allegation that staff administered medication that the resident did not need, it was alleged that Milk of Magnesia was provided to Resident 1 (R1) to ensure that the individual diaper changes R1 as a result of a loose bowel movement caused by the medication. Per review of the Medication Administration Records (MARs), Milk of Magnesia was not prescribed to R1 by Compassionate Hospice Care. In addition, three of five individuals interviewed reported not administering Milk of Magnesia to R1 stating that over-the-counter medications require a doctor’s order.

Therefore, this agency has investigated the complaint. Based on the observations made, interviews conducted, and the records reviewed, the above allegations are deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Lead Staff Glenn Navarro, and this report along with the LIC811 were provided during this visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

LIC9099 (FAS) - (06/04)

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