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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005475
Report Date: 02/27/2024
Date Signed: 02/27/2024 03:51:27 PM

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
06/21/2022 and conducted by Evaluator Rosie Quiroz
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220621095243
FACILITY NAME:FOUNTAIN VALLEY SENIOR HOMES 2FACILITY NUMBER:
306005475
ADMINISTRATOR:ALMIRANEZ, ULDARICOFACILITY TYPE:
740
ADDRESS:17690 SAN VICENTETELEPHONE:
(949) 290-6006
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 5DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
11:26 AM
MET WITH:Dolores Martillano, Caregiver and Uldarico Almiranez, Licensee/AdministratorTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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-Residents are being verbally abused while in care
INVESTIGATION FINDINGS:
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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose of concluding and delivering findings to address the allegations listed above. The 10 day visit complaint investigation was conducted on 6/27/2022. On today's date, LPA Quiroz arrived to the facility and was greeted by Caregiver.... and met with Caregiver.... LPA Quiroz called Licensee/Administrator (L/AD) Uldarico Almiranez and discussed purpose of today's visit via telephone.
During the course of the investigation the following documentes were reviewed but not limited to: Physician reports, identification forms, needs and services plans, LIC 500 (Personnel Report) and Resident Roster.
Regarding the allegation “Residents are being verbally abused while in care," the investigation revealed the following: LPA Quiroz conducted multiple interviews with interviewees consisting of residents, staff and other witnesses. Interviews conducted with Eleven of thirteen Interviewees revealed that although staff are busy attending to resident's call lights/buttons that staff employed at Fountain Valley Senior Homes 2 are respectful to residents in care, visitors, professional staff CONTINUED...***This is an amended report***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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 2
Control Number 22-AS-20220621095243
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: FOUNTAIN VALLEY SENIOR HOMES 2
FACILITY NUMBER: 306005475
VISIT DATE: 02/27/2024
NARRATIVE
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CONTINUED...who conduct medical visits to residents residing at the facility.
An anonymous video was received by the department. In the video, LPA is unable to visually see the individuals speaking and therefore unable to confirm who is present, location and time the video took place. In the video a female voice can be heard shouting at an another individual complaining about being woken up to provide assistance. Although the tone and manner of speech proved to be inappropriate, LPA was unable to confirm if the violation pertained to any residents in care.

Therefore based on the preponderance of evidence gathered through interviews, documentation review and observations conducted by LPA Quiroz, the allegation that "Residents are being verbally abused while in care" was found to be UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiencies cited during today's visit.

An exit interview was conducted with facility representative and a copy of this report was provided.


***THIS IS AN AMENDED REPORT***
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2