306005334-10-11-2022-22-AS-LADS-CLNW4H-20221130155732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005334
Report Date: 10/11/2022
Date Signed: 10/11/2022 03:49:54 PM

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
07/28/2022 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220728091448

FACILITY NAME:	WONDER'S YEARS		FACILITY NUMBER:	306005334
ADMINISTRATOR:	JUAN M. GARCIA TRUJILLO		FACILITY TYPE:	740
ADDRESS:	24301 BARK STREET		TELEPHONE:	(949) 215-4087
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	6	CENSUS: 3	DATE:	10/11/2022
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Facility Administrator-Juan Garcia Trujillo		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Due to staff neglect, resident sustained multiple falls, resulting in injuries while in care.
Due to staff neglect, resident's health is deteriorating causing her to lose 25 lbs. while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to this facility. LPA met with Administrator (AD) Juan Garcia Trujillo. and stated the purpose of this visit which was to deliver the final findings for the complaint received on 7/28/22 against this facility. For today’s visit, there are a total of 3 residents in care.

This agency has investigated the complaint alleging that due to staff neglect, resident sustained multiple falls, resulting in injuries while in care. LPA De Perio conducted file reviews, staff and resident interviews, and based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022

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-20220728091448

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: WONDER'S YEARS	FACILITY NUMBER: 306005334
	VISIT DATE: 10/11/2022

NARRATIVE

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This agency has investigated the complaint alleging that due to staff neglect, resident's health is deteriorating causing her to lose 25 lbs. while in care. LPA De Perio conducted file reviews, staff and resident interviews, and based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

LPA De Perio conducted an exit interview with AD Trujillo and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022

LIC9099 (FAS) - (06/04)

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