306005402-9-5-2023-22-AS-SSAS-CVPQVJ-20230915123025

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005402
Report Date: 09/05/2023
Date Signed: 09/05/2023 04:03:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
08/19/2021 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210819102037

FACILITY NAME:	ENDEAVORS RESIDENTIAL CARE		FACILITY NUMBER:	306005402
ADMINISTRATOR:	PENALOSA, BRANDON		FACILITY TYPE:	735
ADDRESS:	9301 BIXBY AVENUE		TELEPHONE:	(310) 938-0700
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY:	4	CENSUS: 3	DATE:	09/05/2023
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Rolly Serrano		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff member is not qualified.

INVESTIGATION FINDINGS:

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This unannounced visit conducted by Ruth Martinez, Licensing Program Analyst (LPA), is being conducted to conclude this agency’s investigation into the complaint allegation mentioned above. LPA arrived at facility was greeted by staff and granted entry.

During the course of this investigation LPA conducted interviews with staff and copies of pertinent documents obtained. It is alleged that staff member is not qualified. Interview with staff 2 of 2 revealed that staff 1 (S1) was the house manager and was responsible for the facility when the Administrator is not available. Staff indicated when the department conducts visits, they identify as being in charge as the house manager. LPA Martinez reviewed and verified staff have a criminal record clearance and is associated to the facility. LPA Martinez is unable to verify with LPA August when conducting site visit that S1 identified as the Administrator

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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-20210819102037

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ENDEAVORS RESIDENTIAL CARE	FACILITY NUMBER: 306005402
	VISIT DATE: 09/05/2023

NARRATIVE

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due to LPA August no longer being with the Department. Interview with Administrator revealed that S1 was the house manager while taking Administrator certificate course to have S1 become the Administrator for the facility. Based on interviews and lack of corroborating witnesses to complaint in question, there wasn’t enough evidence to prove or refute that the allegation happened as reported.

Based on the information mentioned above, the Department is unable to ascertain if the allegations 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 violation occurred; therefore, these allegations are deemed Unsubstantiated.

An exit interview was conducted with facility representative and a copy of this LIC9099 report was left at facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC9099 (FAS) - (06/04)

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