306005434-2-10-2023-22-AS-AORZ-CSBUZR-20230530160155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005434
Report Date: 02/10/2023
Date Signed: 02/10/2023 01:59:14 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
11/04/2020 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201104173351

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:	01:25 PM
MET WITH:	House Manager, Thomas Duffy		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Staff are refusing to wear a mask
Staff are violating residents personal rights
Uncleared individual is present at the facility

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 and LPM Alisa Ortiz interviewed staff and residents as well as toured the facility. LPA toured the facility kitchen, living room, bedrooms, and backyard patio. Regarding the allegation Staff are refusing to wear a mask, the investigation revealed the following: 2 out of 3 staff stated that one staff member does not always wear a face mask. Interviews with residents report that all staff are wearing masks. Investigation photos revealed staff member was not wearing a mask while in proximinty of resident. Regarding the allegation that Staff are violating residents rights the Investigation revealed that 2 out of 2 residents interviewed, stated that they don’t have problems with staff nor feel that their personal rights are being violated. Regarding the allegation Uncleared individual is present at the facility, the investigation revealed...CONTINUED ON 9099C dated 2/10/23

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 703-2840
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-20201104173351

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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During the investigation only 1 out of 5 interviewed revealed information about an uncleared individual present at facility. At time of visit LPA and LPM did not observe uncleared individual at facility.

This agency has investigated the complaint alleging Staff are refusing to wear a mask, Staff are violating residents personal rights and uncleared individual is present at facility. 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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