306005334-10-11-2022-22-AS-LADS-CLNW4G-20221130155731

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005334
Report Date: 10/11/2022
Date Signed: 10/11/2022 03:48:22 PM

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
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:	02:35 PM
MET WITH:	Facility Administrator-Juan Garcia Trujillo		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff administers sedatives to resident to make her sleep for longer hours.

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 staff administers sedatives to resident to make resident sleep for longer hours. On the visit conducted on 8/3/22, LPA De Perio interviewed staff and inquired about when evening and bedtime medications were given and was informed that per prescription, evening medications are supposed to be given between 7:00 PM – 7:30 PM, and bedtime medications between 7:30 PM – 8:00 PM. On 8/5/22, LPA De Perio conducted an unannounced continuation visit at facility. .

Substantiated

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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At 5:52 PM, LPA De Perio observed three residents in bed. One of the three residents was able to verbalize to LPA De Perio "They gave my pills too early again. I'm sleepy". LPA De Perio reviewed the bubble packs of medications for all the residents and inquired to AD Trujillo what time “sleeping medications” were given. AD Trujillo stated, "We give it to them between 6 to 6:30. But we just happen to give it early today" When asked what time evening and bedtime medications were given to residents on 8/5/22, AD Trujillo stated, "around 5”. Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED

For today's visit citations were issued per Title 22 Division 6 of the California Code of Regulations.
See LIC9099-D.

LPA De Perio conducted an exit interview with AD Trujillo and a copy of this report, regulation discussed and specified on LIC9099-D and Appeal Rights were 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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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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/11/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/25/2022 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (3) To be free from...interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidence by:	1 2 3 4 5 6 7	As a plan of correction (POC), administrator will provide training to staff with the regulation specified, and will submit proof of training to CCL and assigned LPA on or by 10/25/2022.
	8 9 10 11 12 13 14	Based on interviews conducted, file reviews and observations, facility did not adhere to the regulation specified due to interfering with residents living functions such as sleeping. This poses an immediate threat on the safety of residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

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 appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022

LIC9099 (FAS) - (06/04)

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