306005384-11-15-2021-22-AS-MVAO-CG3S9A-20220706134024

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005384
Report Date: 11/15/2021
Date Signed: 11/15/2021 02:52:28 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
08/24/2021 and conducted by Evaluator Albert Marin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210824100223

FACILITY NAME:	ALLORA SENIOR LIVING		FACILITY NUMBER:	306005384
ADMINISTRATOR:	KEVIN ISMAILI		FACILITY TYPE:	740
ADDRESS:	27532 CABEZA		TELEPHONE:	(949) 436-5238
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 5	DATE:	11/15/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator Kevin Ismaili		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff do not provide appropriate care and supervision to the residents while in care.
Residents are being forced to sleep.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to deliver the findings for the complaint filed against this facility last August 24, 2021. LPA met with Administrator (AD) Kevin Ismaili and stated the purpose of this visit.

On allegation that staff do not provide appropriate care and supervision to the residents while in care, the following are the findings. Based on observation, file review and interviews, two staff members start in the morning assisting the residents with their needs which included but not limited to bathing, meals, and medications. After the regular working hours, one staff member stays behind to assist residents on as needed basis. Per interviews, Four out of four witnesses stated that they did not observe any issues with the care and services being provided by the facility. LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021

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-20210824100223

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: ALLORA SENIOR LIVING	FACILITY NUMBER: 306005384
	VISIT DATE: 11/15/2021

NARRATIVE

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On allegation that residents are being forced to sleep, the following are the findings. Based on observation and interviews, the facility is regularly serving dinner between 4:30 PM to 5:00 PM. After dinner residents are assisted per need and are prepared for the night. Per interviews, some residents preferred to stay in the common area and were supervised by on call staff member. Four out of four witnesses denied that residents were forced to sleep. Thus the allegation is deemed UNSUBSTANTIATED.

LPA Marin conducted an exit interview with Administrator Kevin Ismaili and copy of this report was left in the facility.

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SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021

LIC9099 (FAS) - (06/04)

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