306005434-2-10-2023-22-AS-AORZ-CRXTHK-20230518144451

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005434
Report Date: 02/10/2023
Date Signed: 02/10/2023 02:34:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
06/22/2022 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220622082849

FACILITY NAME:	SENIOR ASSISTED CARE HOMES		FACILITY NUMBER:	306005434
ADMINISTRATOR:	MARK STRAUSS		FACILITY TYPE:	740
ADDRESS:	15311 CASCADE LANE		TELEPHONE:	(818) 631-3474
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92647
CAPACITY:	6	CENSUS: 0	DATE:	02/10/2023
		UNANNOUNCED	TIME BEGAN:	02:06 PM
MET WITH:	House Manager, Thomas Duffy		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre made an unanounced visit to deliver findings on a complaint investigation. LPA identified themselves and discussed the purpose of the visit and the elements of the allegation with House Manager Thomas Duffy.

During the investigation, LPA Jenifer Tirre toured facility, gathered pertinent documents and conducted interviews. Regarding the allegation that facility is in disrepair, Investigation revealed that facility had plumbing issue with floor drain in restroom which overflowed with water. Interviews revealed staff had cleaned up area where water was flowing and contacted a plumber. Facility provided department with documentation of pipe repairs. During visit on 6/28/22 LPA observed facility restroom, resident rooms and kitchen. LPA did not observe any water damage to any of the flooring or walls.

CONTINUED ON 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

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-20220622082849

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SENIOR ASSISTED CARE HOMES	FACILITY NUMBER: 306005434
	VISIT DATE: 02/10/2023

NARRATIVE

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This agency has investigated the complaint alleging facility is in disrepair. Based on documents reviewed, interviews conducted and observations the allegations are deemed UNSUBSTANTIATED. All though the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur.

An exit interview was conducted with House Manager and a copy of this report was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023

LIC9099 (FAS) - (06/04)

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