306005334-5-2-2023-22-AS-SSAS-CRNVVN-20230509164636

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005334
Report Date: 05/02/2023
Date Signed: 05/02/2023 03:55:04 PM

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
04/26/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230426143812

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: 2	DATE:	05/02/2023
		UNANNOUNCED	TIME BEGAN:	01:59 PM
MET WITH:	Facility Administrator-Juan Garcia Trujillo		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility does not provide a comfortable environment for residents in care.
Adult in the home yells at residents.
Facility does not provide activities for the residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio made an unannounced 10-day visit to this facility to conduct an investigation for the complaint received on 4/26/23 and to deliver the findings. LPA De Perio explained reason for visit and was greeted and granted entry by facility administrator (AD) Juan Garcia Trujillo.

For today's visit, there are a total of 2 residents in care of which 2 are on hospice and 2 staff on duty.

LPA De Perio conducted a tour of the facility and conducted interviews which consisted of staff and residents, and reviewed and requested copies of the pertinent records.

This department has investigated the complaint alleging that facility does not provide a comfortable environment for residents in care. (SEE LIC9099-C)

Unfounded

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: 05/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023

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-20230426143812

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: 05/02/2023

NARRATIVE

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LPA De Perio conducted a total of 4 interviews which consisted of staff and residents, of which 4 out of the 4 interviews conducted did not corroborate with the allegation. 2 out of the 4 interviews conducted stated that the facility is "good" and that "staff are nice". During the tour of the facility, LPA also observed that all residents rooms were provided with furniture in good repair. LPA reviewed the following documents such as but not limited to: resident 1 and resident 2 physician reports, and functioning assessments, and facility admission agreement. Based on observations and review of documents obtained, 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.

This department has investigated the complaint alleging that adult in the home yells at residents. LPA De Perio conducted a total of 4 interviews which consisted of staff and residents, of which 4 out of the 4 interviews conducted did not corroborate with the allegation. 2 out of the 4 interviews denied of ever witnessing or hearing a staff yell at a resident, and denied of ever being yelled at. LPA reviewed the following documents such as but not limited to: resident 1 and resident 2 physician reports, and functioning assessments, and house rules. Based on observations and review of documents obtained, 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.

This department has investigated the complaint alleging that facility does not provide activities for the residents. LPA De Perio conducted a total of 4 interviews which consisted of staff and residents, of which 4 out of the 4 interviews conducted did not corroborate with the allegation, by stating that the facility has an activity schedule. 3 out of the 4 interviews conducted stated that the facility has activity supplies to use, however, the preferred activity for the current residents is to watch television. During the tour of the facility, LPA De Perio observed that the facility had activity supplies such as: Bingo, card games, board games, coloring and arts and crafts. LPA reviewed the following documents such as but not limited to: resident 1 and resident 2 physician reports, and functioning assessments, and the facility activity schedule. Based on observations and review of documents obtained, 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.

For today's visit, no citation was issued. An exit interview was conducted and a copy of this report was provided and explained to AD Trujillo.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2023

LIC9099 (FAS) - (06/04)

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