306005410-10-30-2023-22-AS-AORZ-CXEULB-20231109144028

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005410
Report Date: 10/30/2023
Date Signed: 10/30/2023 12:21:26 PM

Unfounded

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
10/26/2023 and conducted by Evaluator Andrea Mendivil

COMPLAINT CONTROL NUMBER: 22-AS-20231026084551

FACILITY NAME:	SERENTO ROSA		FACILITY NUMBER:	306005410
ADMINISTRATOR:	HRAG BEKERIAN		FACILITY TYPE:	741
ADDRESS:	17803 IMPERIAL HIGHWAY		TELEPHONE:	(714) 777-9666
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	135	CENSUS: 69	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Russell Boydston- Interim Executive Director		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff does not ensure telephone system is in good repair

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by Health Services Director Angie Perez, and explained the reason for the visit. Interim Executive Director Russell Boydston arrived shortly after.

The department received a complaint on 10/26/2023 and the initial visit was conducted on 10/30/2023. LPA Mendivil interviewed staff, residents and witnesses. Regarding the allegation staff does not ensure telephone system is in good repair, the investigation revealed the following:

During the visit LPA Mendivil observed reception picking up phone calls within two rings. Based on interviews with 3 out of 3 staff indicate the phone is forwarded to a cordless phone after the hour of 8pm which is provided to PM and nocturnal shift staff.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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-20231026084551

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: SERENTO ROSA	FACILITY NUMBER: 306005410
	VISIT DATE: 10/30/2023

NARRATIVE

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Based on interviews with 3 out of 4 residents reported they have cell phones. 1 out of 4 residents stated they are reached through facility line.

Executive Director Russell Boydston reported that some residents have their own personal cell phones and some residents have land lines. Executive Director Russell reported that the facility is in the process of forwarding calls to facility cell phones. Health Services Director Angie Perez stated she will call the facility after hours to ensure that staff is answering the phones, and she stated they will answer.

Based on interview with witnesses it was reported on 10/25/2023 they were unable to reach anyone through the Assisted Living line, so they called Memory Care and Skilled Nursing to have them contact Assisted Living. It was reported by the witnesses their family member does not have a cell phone to reach them so they rely on the facility line.

Therefore, based on interviews and observations the allegation Staff does not ensure telephone system is in good repair is determined to be UNFOUNDED, meaning the allegation is false could not have happened and/or is without a reasonable basis.

No deficiencies noted in today's visit.

An exit interview was conducted and a copy of the report provided.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

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