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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005334
Report Date: 06/02/2023
Date Signed: 06/02/2023 12:15:53 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
05/03/2023 and conducted by Evaluator Celine DePerio
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230503123146
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: 1DATE:
06/02/2023
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Facility Staff- Mariadelos Trujillo Cruz TIME COMPLETED:
12:37 PM
ALLEGATION(S):
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Facility did not issue a refund to resident.
Facility did not provide an admission agreement to resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings for the complaint received on 5/3/23. LPA arrived to the facility, explained reason for visit, was greeted and granted entry by staff on duty (S1), Mariadelos Trujillo Cruz.

It was alleged that the facility did not issue a refund to resident. LPA conducted a total of 6 interviews which consisted of staff, residents, and external parties. 3 out of the 6 interviews conducted corroborated with the allegation, of which 1 provided a direct admission admitting to not issuing a refund. LPA reviewed documents such as the facility admission agreement, financial documents and bank statements. It was observed that the resident provided the facility with a "months worth" check, however, resident only resided at the facility from 4/22/23 to 4/30/23.
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: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
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 5
Control Number 22-AS-20230503123146
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: 06/02/2023
NARRATIVE
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It was alleged that the facility did not provide an admission agreement to resident. LPA conducted a total of 6 interviews which consisted of staff, residents, and external parties. 3 out of the 6 interviews corroborated with the allegation by stating that an admission agreement was never provided. 1 of the interviews stated “there were no talks of anything to do with an admission agreement…I think that's the issue right now with the refund" (regarding to the previous allegation). 1 of the interviews also provided a direct admission of not providing the resident (R1) with an admission agreement. LPA reviewed documents such as the facility admission agreement and R1’s file, of which it was observed that the facility did not have a copy of the signed admission agreement from R1 because it was not provided.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, the preponderance of evidence standard has been met, therefore the allegations are SUBSTANTIATED.

An exit interview was conducted with S1 and facility administrator (AD) Juan Garcia Trujillo via phone call. A copy of this report was provided and explained.

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

DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
05/03/2023 and conducted by Evaluator Celine DePerio
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230503123146

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: 1DATE:
06/02/2023
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Facility Staff- Mariadelos Trujillo Cruz TIME COMPLETED:
12:37 PM
ALLEGATION(S):
1
2
3
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5
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9
Facility not serving food that is of quality.
Facility staff not following physical therapists instructions.
Facility not allowing resident to drink coffee.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings for the complaint received on 5/3/23. LPA arrived to the facility, explained reason for visit, was greeted and granted entry by staff on duty (S1), Mariadelos Trujillo Cruz.

It was alleged that the facility not serving food that is of quality. LPA conducted a total of 6 interviews which consisted of staff, residents, and external parties. 1 of the interviews did not corroborate with the allegation by stating “the food is good”. 2 of the interviews stated that if there were complaints of the food, the facility staff would take pictures of the meals prior to serving it as “proof” of what kind of food is being served. LPA reviewed pertinent documents such as the facility menu, the physician report of the resident, and photos. It was observed that the facility was serving food that included protein, carbs, vegetables, fruits, and would adhere to the resident’s dietary instructions if applicable.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20230503123146
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: 06/02/2023
NARRATIVE
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It was alleged that facility staff not following physical therapists instructions. LPA conducted a total of 6 interviews which consisted of staff, residents and external parties. 4 out of the 6 interviews conducted stated that the resident in the allegation (R1) had a physician therapy assessment conducted, however, no official instructions were provided. It was also stated that that the physical therapist had scheduled a second session with R1, however, by the time the session came, R1 had already moved out of the facility. LPA reviewed pertinent documents, however 1 interview specified that everything regarding physical therapy was “verbal and nothing was written”.

It was alleged that the facility not allowing resident to drink coffee. LPA conducted a total of 6 interviews which consisted of staff, residents, and external parties. 4 out of the 6 interviews conducted did not corroborate with the allegation by stating that the facility does offer and serve coffee to residents. LPA reviewed pertinent documents such as the facility menu, the physician report of the resident, and photos. It was observed that the pictures of the meals the facility served (regarding to previous allegation), also included pictures of the resident drinking coffee. LPA conducted a tour of the facility and also observed that the facility is supplied with coffee.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, this allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with S1 and facility administrator (AD) Juan Garcia Trujillo via phone call. A copy of this report was provided and explained.

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

DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20230503123146
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: 06/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2023
Section Cited
CCR
87507(a)
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87507 Admission Agreements
(a) The licensee shall complete an individual written admission agreement...with each resident or the resident's representative, if any.
This requirement is not met as evidence by:
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As plan of correction (POC), facility will review the regulation cited, and will provide proof of understanding to the assigned LPA on or by 6/16/23.
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Based on LPA's observations, interviews and record reviews, facility failed to complete an indiviudal written admission agreement....
This poses a potential health and safety risk to residents in care.
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Type B
06/16/2023
Section Cited
CCR
87507(5)(c)
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87507 Admission Agreements
(5) Refund conditions
(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued...
This requirement is not met as evidence by:
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As plan of correction, (POC) facility will issue the resident a refund for the amount reflected of when resident was no longer residing at the facility. Facility will provide proof of refund and the regulation cited to the assigned LPA on or by 6/16/23.
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Based on LPA's observations, interviews and record reveiws, facility failed to issue a refund of any fees paid in advance covering the time after the resident's personal properly has been removed...
This poses a potential health and safety risk to residents 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: 06/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5