306005359-1-12-2023-22-AS-SSAS-CN9P7Z-20230120100445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005359
Report Date: 01/12/2023
Date Signed: 01/12/2023 01:23:33 PM

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
04/23/2021 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210423103407

FACILITY NAME:	CLOSE TO HOME SENIOR CARE III		FACILITY NUMBER:	306005359
ADMINISTRATOR:	PARNELL, MARICAR		FACILITY TYPE:	740
ADDRESS:	1148 E CHESTNUT AVE		TELEPHONE:	(714) 872-0965
CITY:	ORANGE	STATE: CA	ZIP CODE:	92867
CAPACITY:	6	CENSUS: 5	DATE:	01/12/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Maricar Parnell - Administrator		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Facility refused paramedics entry
Facility did not allow resident to chose their own hospice company
Facility did not allow for visitations

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced subsequent complaint visit to deliver the findings of the investigation into the above allegations. LPA Velazquez was allowed entry into the facility and met with Administrators Maricar Parnell and Gregory Parnell and explained the purpose of the visit.

On today's visit LPA Velazquez observed the 5 residents in care were either dining or watching TV and appeared well-cared for. During the course of the investigation LPAs Ruth Martinez and Patricia Velazquez conducted interviews with the complainant, residents, and staff. LPA Velazquez obtained facility, resident, and staff records. The records reviewed included Preplacement Appraisal Information, Physician's Report, Appraisal Needs and Services Plan, Centrally Stored Medication and Destruction Record, Functional Capability Assessment, Durable Power of Attorney (DPOA) documents, photos of Resident (R) #1 depicting their skin status free of any wounds or bruising on the date R1 moved out, letter from Attorney Lawrence Hoodack requesting R1's personal belongings, invoices for $9800.00 and $10,190.00 overdue fees owed to the facility,

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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-20210423103407

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: CLOSE TO HOME SENIOR CARE III	FACILITY NUMBER: 306005359
	VISIT DATE: 01/12/2023

NARRATIVE

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and letter to Attorney Lawrence Hoodack acknowledging items returned that belonged to R1. R1 was admitted to the facility on May 28, 2018 with the Admission Agreement signed by R1's DPOA on May 28, 2018. R1 was a resident of the facility until they moved out on April 21, 2021. Regarding the allegation: Facility refused paramedics entry four of four individuals interviewed provided conflicting statements and could not corroborate the allegation. Three of the four individuals interviewed stated they never refused paramedics entry but indicated the paramedics did not want to enter the facility when asked if they wanted to enter. Regarding the allegation: Facility did not allow resident to chose their own hospice company, four of four individuals interviewed provided conflicting statements and could not corroborate the allegation. Three of the four individuals interviewed stated the resident and/or their responsible party or DPOA are the ones who make the decision which hospice agency they wish to utilize. Regarding the allegation: Facility did not allow for visitations, four of four individuals interviewed provided conflicting statements and could not corroborate the allegation. Three of the four individuals interviewed stated that during the height of the COVID-19 Pandemic facilities were not allowing in person visitation pursuant to the directives of the local Department of Public Health and the CA Department of Social Services. The facility then utilized other forms of visitation such as virtual visits utilizing various platforms such as FaceTime, window visits, and telephone calls.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the following allegations: Facility refused paramedics entry, Facility did not allow resident to chose their own hospice company, and Facility did not allow for visitations are deemed UNSUBSTANTIATED.

An exit interview was conducted with Administrators Maricar Parnell and Gregory Parnell and a copy of this report along with the LIC 811 was provided at the time of this visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC9099 (FAS) - (06/04)

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