<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005442
Report Date: 01/04/2023
Date Signed: 01/04/2023 11:35:41 AM

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
12/28/2022 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221228140627
FACILITY NAME:EASTERSEALS SOUTHERN CALIFORNIA - COUNTRY HILLSFACILITY NUMBER:
306005442
ADMINISTRATOR:SEAN ESTRELLAFACILITY TYPE:
735
ADDRESS:640 WEST COUNTRY HILLS DRIVETELEPHONE:
(714) 526-4079
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:4CENSUS: 4DATE:
01/04/2023
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Sean EstrellaTIME COMPLETED:
11:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not maintain the facility in good repair
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Administrator (AD) Sean Estrella, discussed the purpose of the inspection, and explained the allegation. The investigation into the allegation that Licensee does not maintain the facility in good repair revealed the following: During the course of the investigation, LPA inspected the facility, conducted health and safety checks on the residents, interviewed AD, 2 staff, and 2 residents, and requested and reviewed copies of the resident roster and staff roster.

LPA observed that the microwave in the kitchen was not working. AD and staff interviewed stated that the microwave stopped working very recently about 3 or 4 days ago. AD stated that the facility is working on replacing it, but it cannot be immediately replaced because it is built into the cabinets of the kitchen, and that in the meantime staff are using a toaster oven, the stove, and the oven to prepare food. During the inspection, the facility purchased and installed a new microwave.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
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-20221228140627
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: EASTERSEALS SOUTHERN CALIFORNIA - COUNTRY HILLS
FACILITY NUMBER: 306005442
VISIT DATE: 01/04/2023
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
During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20221228140627
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: EASTERSEALS SOUTHERN CALIFORNIA - COUNTRY HILLS
FACILITY NUMBER: 306005442
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/11/2023
Section Cited
CCR
80087(a)
1
2
3
4
5
6
7
80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times… This requirement was not met as evidenced by:
1
2
3
4
5
6
7
During the inspection, the licensee purchased and installed a new microwave.

POC CLEARED.
8
9
10
11
12
13
14
Based on observations and interviews, the licensee did not ensure the facility’s microwave was in good repair for 3 or 4 days, which poses a potential health and personal rights risk to 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.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 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
12/28/2022 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221228140627

FACILITY NAME:EASTERSEALS SOUTHERN CALIFORNIA - COUNTRY HILLSFACILITY NUMBER:
306005442
ADMINISTRATOR:SEAN ESTRELLAFACILITY TYPE:
735
ADDRESS:640 WEST COUNTRY HILLS DRIVETELEPHONE:
(714) 526-4079
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:4CENSUS: 4DATE:
01/04/2023
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Sean EstrellaTIME COMPLETED:
11:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not meet residents' incontinence needs
Staff do not meet residents' grooming needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegations. LPA met with Administrator (AD) Sean Estrella, discussed the purpose of the inspection, and explained the allegations. The investigation into the allegations that Staff do not meet residents' incontinence needs and Staff do not meet residents' grooming needs revealed the following: During the course of the investigation, LPA inspected the facility, conducted health and safety checks on the residents, interviewed AD, 2 staff, and 2 residents, and requested and reviewed copies of the resident roster and staff roster.

LPA conducted health and safety checks on the 2 residents present and observed no health and safety issues, observed that these residents were not soiled, and did not observe any rashes. Both residents are non-verbal. LPA inspected 4 resident rooms and observed no urine, feces, or unpleasant smells. LPA observed the entire facility was clean, organized, well furnished, and comfortable.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20221228140627
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: EASTERSEALS SOUTHERN CALIFORNIA - COUNTRY HILLS
FACILITY NUMBER: 306005442
VISIT DATE: 01/04/2023
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
Interviews with AD and 2 staff did not reveal any issues with the incontinence care the residents receive. AD and staff explained that 2 residents need incontinence care, the facility has a procedure to provide that incontinence care, and staff are trained and understand the procedure. LPA observed the facility has approximately 9 packages of diapers/pull-ups with each package containing approximately 18 diapers. AD stated the facility always has enough diapers and purchases more regularly.

LPA inspected the residents’ rooms and observed that all 4 residents have at least 30 pieces of upper body clothing, 20 pieces of lower body clothing, as well as additional pieces of clothing. LPA observed that 1 resident has a smaller variety of clothing than the others, but AD and staff explained that that resident prefers only to wear specific types of clothes and will refuse other types of clothes. LPA observed that the residents’ clothes were not overly worn and LPA did not observe holes in the clothes.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegation are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5