306005442-2-26-2024-22-AS-AJLO-D33NX3-20240305095028

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005442
Report Date: 02/26/2024
Date Signed: 02/26/2024 09:16:14 AM

Unsubstantiated

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
06/06/2022 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220606132329

FACILITY NAME:	EASTERSEALS SOUTHERN CALIFORNIA - COUNTRY HILLS		FACILITY NUMBER:	306005442
ADMINISTRATOR:	ARMANDO FLORES		FACILITY TYPE:	735
ADDRESS:	640 WEST COUNTRY HILLS DRIVE		TELEPHONE:	(714) 526-4079
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	4	CENSUS: 4	DATE:	02/26/2024
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Daniel Vazquez		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Medical attention is not being sought for resident in a timely manner.

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation(s). LPA met with Staff #1 (S1) Daniel Vazquez and explained the reason for today’s inspection. Administrator (AD) Sean Estrella appeared via telephone.

The investigation into the allegation that medical attention is not being sought for resident in a timely manner revealed the following: During the course of the investigation, LPA inspected the facility, conducted health and safety checks, interviewed the former administrator, staff, and clients, and obtained and reviewed copies of the resident roster, staff roster, and Client #1’s (C1) Medical Records dated 04/07/22 to 06/04/22.

Regarding the allegation that medical attention is not being sought for resident in a timely manner: It was alleged that C1’s health recently began to decline due to a gastrointestinal issue and the facility has not sought medical attention for C1 in a timely manner.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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-20220606132329

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: 02/26/2024

NARRATIVE

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LPA inspected the facility and observed no health and safety issues. LPA conducted health and safety checks on the facility’s four clients and observed no health and safety concerns or signs of neglect. LPA attempted to interview C1, but C1 is non-verbal. LPA interviewed three staff who stated that C1’s health has declined recently due to a gastrointestinal issue. Two of the staff reported that C1 has not been taken to a hospital, but has been seen by medical professionals at the facility. LPA interviewed the former administrator who was the administrator during the time period involved in the allegation. The former administrator reported that C1 does not tolerate vehicle transport, so C1 is not taken to the hospital and is instead seen by medical professionals at the facility. The former administrator detailed the history of C1’s gastrointestinal issue and stated that C1 is seen by medical professionals at the facility often and regularly, the prescribed treatment is having an effect, the former administrator has worked closely with the rest of the care team to coordinate C1’s medical care, Regional Center of Orange County and C1’s responsible party approve of the treatment plan, and facility staff were informed about C1’s medical condition, treatment plan, and the recommendations ordered by the medical professionals. LPA reviewed C1’s Medical Records dated 04/07/22 to 06/04/22 which detail the history of C1’s gastrointestinal issue, show the treatment provided to C1 by medical professionals, and do not indicate any medical professional recommended C1 be treated at a hospital as opposed to continuing to receive care at the facility. LPA did not obtain any information corroborating the allegation.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC9099 (FAS) - (06/04)

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