306005374-7-11-2023-22-AS-SSAS-CUC3GH-20230802181419

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005374
Report Date: 07/11/2023
Date Signed: 07/11/2023 11:48:12 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
04/27/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230427105559

FACILITY NAME:	EVER CARE		FACILITY NUMBER:	306005374
ADMINISTRATOR:	MOKHTARZAD, SHAHIN		FACILITY TYPE:	740
ADDRESS:	24985 HENDON ST		TELEPHONE:	(949) 616-4785
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	6	CENSUS: 6	DATE:	07/11/2023
		UNANNOUNCED	TIME BEGAN:	08:43 AM
MET WITH:	Facility Administrator - Shahin Mokhtarzad		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Staff do not assist resident with toileting in a timely manner.
Staff yelled at resident.
Staff did not clean resident adequately resulting in a wound.
Staff do not meet resident's care needs.

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 04/27/23. LPA De Perio explained the purpose of today's visit, was greeted, and granted entry by facility administrator (AD) Shahin Mokhtarzad about visit.

It was alleged that staff do not assist resident with toileting in a timely manner. LPA De Perio conducted a total of 8 interviews which consisted of staff and residents. 5 out of the interviews conducted did not corroborate with the allegation, of which one of the interviews stated "they do help us" and further explained that staff will assist with toileting in the morning, afternoon, in the evening, and whenever the resident calls for staff. 3 out of the 8 interviews were unable to be conducted due to declining of wanting to be interviewed. LPA De Perio conducted a tour of the facility on 05/02/2023, and observed staff on duty assisting a resident with toileting in the restroom. It was also observed that facility is equipped with toileting and incontinence supplies.

Unsubstantiated

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: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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-20230427105559

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: EVER CARE	FACILITY NUMBER: 306005374
	VISIT DATE: 07/11/2023

NARRATIVE

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It was alleged that staff yelled at resident. LPA De Perio conducted a total of 8 interviews which consisted of staff and residents. 5 out of the 8 interviews conducted did not corroborate with the allegation, of which all 5 interviews denied of ever witnessing and hearing a staff member yell at a resident. 3 out of the 8 interviews were unable to be conducted due to declining of wanting to be interviewed. LPA De Perio also reviewed the facility house rules.

It was alleged that staff did not clean resident adequately resulting in a wound. LPA De Perio conducted a total of 9 interviews which consisted of staff, residents, and external parties. 6 out of the 9 interviews conducted did not corroborate with the allegation, of which 1 interview with a resident stated "they thoroughly clean us to make sure we don't get any sores or anything like that". 3 out of the 9 interviews were unable to be conducted due to declining of wanting to be interviewed. LPA De Perio reviewed the resident's (R1) physician report, and contacted R1's physician who confirmed that R1 already had a sore prior to admission into the facility. During the tour of the facility, LPA De Perio observed that the facility has topical ointment that is made inaccessible to residents in care, of which 1 interview stated "if the resident needs ointment or cream, we have it, but we get the "okay" from the doctor first, but we have it here just in case".

It was alleged that staff do not meet resident's care needs. LPA De Perio conducted a total of 8 interviews which consisted of staff and residents. 5 out of the 8 interviews conducted did not corroborate with the allegation, of which 2 of the interviews specified "I would say my needs are met, so it's good" and "my needs are met, I don't have anything bad to report". 3 out of the 8 interviews were unable to be conducted due to declining of wanting to be interviewed. During the tour of the facility, there were no health and safety concerns noted, and it was observed that the residents care needs were met.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations are deemed UNSUBSTANTIATED.

For today's visit, no citations were issued.

An exit interview was conducted with AD Mokhtarzad. A copy of this report was provided and explained.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC9099 (FAS) - (06/04)

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