306005410-4-7-2023-22-AS-SSAS-CQUUNF-20230413154351

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005410
Report Date: 04/07/2023
Date Signed: 04/07/2023 01:14:57 PM

Substantiated

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
03/30/2023 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230330103656

FACILITY NAME:	SERENTO ROSA		FACILITY NUMBER:	306005410
ADMINISTRATOR:	SHANNON HUNDLEY		FACILITY TYPE:	741
ADDRESS:	17803 IMPERIAL HIGHWAY		TELEPHONE:	(714) 777-9666
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	135	CENSUS: 57	DATE:	04/07/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Hrag Bekerian		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Staff did not allow resident reasonable access to a telephone

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Executive Director (ED) Hrag Bekerian and explained the reason for the visit. The investigation into the allegation, staff did not allow resident reasonable access to a telephone, revealed the following. It was alleged, the facility did not answer the telephone at 7:30 am on or around March 21, 22, 2023 and after 8:00 pm on March 29, 2023. LPA called the facility number 714-777- 9666 at 7:45 am on April 7, 2023, the phone rang 12 times and no one answered. LPA called the facility number at 9:08 pm on April 6, 2023 and the phone rang for 3 minutes and no one answered. The phone system is operational. ED Bekerian verified that the phone rings to the wellness office from 8:00 pm to 8:00 am but staff are not working in the office they are throughout the facility assisting residents. Based on the evidence the gathered through interviews and observation the preponderance of evidence standard has been met, therefore the allegation, staff did not allow resident reasonable access to a telephone is deemed substantiated. Even though the phone system is operational the residents must have reasonable access to telephones to receive calls. (Continued)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 5

Control Number 22-AS-20230330103656

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: 04/07/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report along with citation and Appeal Rights (LIC 9058 01/16) was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

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
03/30/2023 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230330103656

FACILITY NAME:	SERENTO ROSA		FACILITY NUMBER:	306005410
ADMINISTRATOR:	SHANNON HUNDLEY		FACILITY TYPE:	741
ADDRESS:	17803 IMPERIAL HIGHWAY		TELEPHONE:	(714) 777-9666
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	135	CENSUS: 57	DATE:	04/07/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Hrag Bekerian		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Ground level units do not have hot water
Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA met with Executive Director (ED) Hrag Bekerian and explained the reason for the visit.The investigation into the allegation, ground level units do not have hot water revealed the following. LPA measured hot water in rooms, 104, 105, 124, 128 and 113. Hot water measured from 108.0 degrees Fahrenheit to 120.0 degrees Fahrenheit. Hot water in each room took from 1 minute to 4 minutes to get to temperature. Based on the evidence gathered through observation, the allegation, ground level units do not have hot water is deemed unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis.

Regarding the allegation, facility is in disrepair, the investigation revealed the following. No specifici details were provided with the complaint regarding facility maintenance. LPA toured the facility including memory care. LPA did not observe any doors, floors, windows, furniture or fixtures that were in disrepair.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 22-AS-20230330103656

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: 04/07/2023

NARRATIVE

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LPA did not observe any deficiencies in rooms, 104, 105, 124, 128 or 113 and all the plumbing fixtures were operational in the rooms listed. LPA observed all fire extinguishers were charged and all common light fixtures were operational. Based on the evidence gathered through observation, the allegation, ground level units do not have hot water is deemed unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of the report provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 22-AS-20230330103656

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/07/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/14/2023 Section Cited CCR 87468.1(a)(14)	1 2 3 4 5 6 7	Personal rights of residents in all facilities. To have reasonable access to telephones, to both make and receive confidential calls... This requirement is not being met as evidenced by interviews and observation, facility did not answer the phone on March 29 after 8:00 pm.	1 2 3 4 5 6 7	LIcensee agrees to have a mobile cordless telephone connected to the facility telephone number with facility staff from 8:00 pm to 8:00 am daily to answer the phone. Licensee to submit plan of correction by 4/14/23.
	8 9 10 11 12 13 14	and LPA observed that the facility did not answer the phone at 7:45 am. on 4/7/23 and 9:08 pm on 4/6/23. This poses a potential health and safety risk residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5