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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005334
Report Date: 12/05/2022
Date Signed: 12/05/2022 03:19:42 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
11/07/2022 and conducted by Evaluator Celine DePerio
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221107095603
FACILITY NAME:WONDER'S YEARSFACILITY NUMBER:
306005334
ADMINISTRATOR:JUAN M. GARCIA TRUJILLOFACILITY TYPE:
740
ADDRESS:24301 BARK STREETTELEPHONE:
(949) 215-4087
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 2DATE:
12/05/2022
UNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Staff on duty-Mariadelos "Angie" Trujillo CruzTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff yelled at resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to this facility. LPA De Perio was greeted and granted entry by staff on duty (S1) who contacted facility administrator (AD) Juan Garcia Trujillo about visit. AD Trujillo was unable to be present during time of visit, however, provided consent for S1 to receive and sign report. LPA De Perio stated the purpose of this visit which was to deliver the final findings for the complaint received on 11/7/22 against this facility.

For today’s visit, there are a total of 2 residents in care and 1 staff on duty.

This agency has investigated the complaint alleging that staff yelled at resident in care. 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. See LIC9099-C.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
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-20221107095603
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: 12/05/2022
NARRATIVE
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For today's visit, a citation was issued per Title 22 Division 6 of the California Code of Regulations. See LIC9099-D.

LPA De Perio conducted an exit interview with S1 and copy of this report, LIC9099-D and Appeal Rights were left in this facility.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20221107095603
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: 12/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/05/2022
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities
(a) Residents... shall have all of the following personal rights:
(1) To be accorded dignity in their personal relationships with staff...
This requirement is not met as evidence by:
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As plan of correction, facility will provide training to staff regarding regulation cited and will provide proof to Community Care Licensing and assigned LPA on or by 12/19/22.
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Based on observation, and interviews, facility did not ensure that resident was accorded dignity in their personal relationships with staff. This poses an immediate threat on safety of clients in care.
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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.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3