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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005349
Report Date: 03/08/2023
Date Signed: 03/08/2023 10:46:31 AM

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
11/29/2022 and conducted by Evaluator Michelle Reed
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221129121415
FACILITY NAME:LAS PALMASFACILITY NUMBER:
306005349
ADMINISTRATOR:MONICA CASTILLOFACILITY TYPE:
740
ADDRESS:24962 CALLE ARAGONTELEPHONE:
(949) 586-3393
CITY:LAGUNA WOODSSTATE: CAZIP CODE:
92637
CAPACITY:220CENSUS: 142DATE:
03/08/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Monica CastilloTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Facility did not meet resident's needs
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
Licensing Program Analyst Michelle Reed arrived at the facility to deliver the findings of this complaint investigation. Upon arrival, LPA met with Administrator Monica Castillo. The complaint was investigated and consisted of interviews with the facility staff, Administrator and a review of Resident #1’s records. The following was determined:

Resident #1(R1) was admitted into the facility on 11/11/22. R1 admitted from the skilled nursing connected to the assisted living. R1 was admitted with Dementia, Cervical Disc Disorder and Malnutrition. R1 is non-ambulatory and needed assistance with all ADL’s. Resident began Home Health on 11/14/22 and Hospice care was discussed, however responsible party wanted to wait a couple of weeks.

On 11/25/22 R1 was sent to the hospital due to a change in condition by Home Health. R1 was admitted to the hospital for a high fever and UTI. Based upon interviews with staff and a review of R1’s records, this allegation is unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to Monica Castillo.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
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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