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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005476
Report Date: 05/07/2024
Date Signed: 05/07/2024 10:28:34 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
04/30/2024 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240430121216
FACILITY NAME:ANGELS CARE GUEST HOMEFACILITY NUMBER:
306005476
ADMINISTRATOR:JABONERO, JANICEFACILITY TYPE:
740
ADDRESS:10212 MALINDA LANETELEPHONE:
(714) 244-5885
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:6CENSUS: 6DATE:
05/07/2024
UNANNOUNCEDTIME BEGAN:
08:22 AM
MET WITH:Ruby Cruz, Janice JaboneroTIME COMPLETED:
10:43 AM
ALLEGATION(S):
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The facility failed to issue a refund
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad and RoseMarie Ruppert for the purpose of investigating the above-mentioned complaint allegation. LPAs met with Licensee (LE) Ruby Cruz and Administrator (AD) Janice Jabonero and explained the reason for today’s inspection.

The investigation into the allegation that the facility failed to issue a refund revealed the following: During the course of the investigation, LPAs inspected the facility, interviewed LE, AD, and witnesses, and obtained and reviewed copies of the resident roster, staff roster, and Resident #1’s (R1) Admission Agreement dated March 16, 2024.

CONTINUED
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
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 5
Control Number 22-AS-20240430121216
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: ANGELS CARE GUEST HOME
FACILITY NUMBER: 306005476
VISIT DATE: 05/07/2024
NARRATIVE
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Regarding the allegation that the facility failed to issue a refund: it was alleged that R1 moved into the facility on March 16, 2024, went to the hospital on April 1, 2024, did not return to the facility, R1’s responsible party moved R1 out of the facility and removed R1’s belongings from the facility on April 3, 2024 and requested a refund on that date, but the facility did not provide a refund. LPAs interviewed a witness who confirmed these details. LPAs attempted to interview R1, but R1 is no longer present at the facility. LPAs interviewed LE and AD who corroborated these facts, but denied that a refund was required because no notice was provided. LPAs reviewed R1’s Admission Agreement dated March 16, 2024 which states: “REFUND/PRORATION POLICY. If the resident moves out, the basic rate will continue to accrue until all personal belongings are removed from the facility. Unused rent moneys will be returned fifteen (15) days after room is vacated of all belongings, clothing and furnishings.” Based on R1’s Admission Agreement dated March 16, 2024, no notice was required and the facility should have issued a refund for prorated unused fees starting on April 4, 2024.

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: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20240430121216
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: ANGELS CARE GUEST HOME
FACILITY NUMBER: 306005476
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/04/2024
Section Cited
CCR
87507(g)(5)
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87507 Admission Agreements (g) Admission agreements shall specify the following: (5) Refund conditions. This requirement was not met as evidenced by:
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Licensee stated they will refund prorated unused fees starting on 04/04/24 to R1 and submit proof to LPA by POC due date.
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Based on interviews and documents, the licensee did not follow the admission agreement when they did not provide R1 with a refund after they moved out of the facility, which poses a potential personal rights risk to persons in care.
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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: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
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
04/30/2024 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240430121216

FACILITY NAME:ANGELS CARE GUEST HOMEFACILITY NUMBER:
306005476
ADMINISTRATOR:JABONERO, JANICEFACILITY TYPE:
740
ADDRESS:10212 MALINDA LANETELEPHONE:
(714) 244-5885
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:6CENSUS: 6DATE:
05/07/2024
UNANNOUNCEDTIME BEGAN:
08:22 AM
MET WITH:Ruby Cruz, Janice JaboneroTIME COMPLETED:
10:43 AM
ALLEGATION(S):
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The facility is being operated by an authorized individual
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad and RoseMarie Ruppert for the purpose of investigating the above-mentioned complaint allegation. LPAs met with Licensee (LE) Ruby Cruz and Administrator (AD) Janice Jabonero and explained the reason for today’s inspection.

The investigation into the allegation that the facility is being operated by an unauthorized individual revealed the following: During the course of the investigation, LPAs inspected the facility, interviewed LE and AD, and obtained and reviewed copies of the resident roster, staff roster, the facility’s Administrative Organization (LIC309) dated January 10, 2018, and the facility’s Articles of Incorporation dated March 20, 2017.

CONTINUED
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
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-20240430121216
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: ANGELS CARE GUEST HOME
FACILITY NUMBER: 306005476
VISIT DATE: 05/07/2024
NARRATIVE
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Regarding the allegation that the facility is being operated by an unauthorized individual: it was alleged that the licensee, Granny's Homes Inc, is a corporation, but when the facility requested payment for Resident #1’s (R1) fees, the facility requested that the check be made out to LE, an individual. LPAs interviewed AD who did not have information regarding this allegation. LPAs interviewed LE who admitted these facts and stated that they asked for the money personally in order to give it to a referral agent for a referral fee, but stated that they are the owner of the licensee corporation Granny's Homes Inc. LPAs reviewed the facility’s Administrative Organization (LIC309) dated January 10, 2018 and Articles of Incorporation dated March 20, 2017 which show that LE is a 50% owner of the licensee corporation Granny's Homes Inc, meaning LE is an authorized individual to operate the facility.

The Department has investigated the above allegation and found it to be Unfounded, meaning the allegation was false, could not have happened, or is without reasonable basis. 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: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5