306005476-6-20-2024-22-AS-SSAS-D6KNNU-20240625103716

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005476
Report Date: 06/20/2024
Date Signed: 06/20/2024 04:16:48 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
02/06/2024 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240206120108

FACILITY NAME:	ANGELS CARE GUEST HOME		FACILITY NUMBER:	306005476
ADMINISTRATOR:	JABONERO, JANICE		FACILITY TYPE:	740
ADDRESS:	10212 MALINDA LANE		TELEPHONE:	(714) 244-5885
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92840
CAPACITY:	6	CENSUS: 6	DATE:	06/20/2024
		UNANNOUNCED	TIME BEGAN:	02:29 PM
MET WITH:	Ruby Cruz-Licensee		TIME COMPLETED:	04:31 PM

ALLEGATION(S):

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Facility staff is financially abusing resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on February 06, 2024. LPA was greeted and granted entry into the facility and met with Licensee Ruby Cruz. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that facility staff is financially abusing resident. Resident 1 (R1) was admitted to the facility on August 30, 2023. Documents reviewed included the Physician Report (LIC602) dated August 30, 2023 for R1. Per Physician report R1’s diagnoses is malignant neoplasm of left kidney and is not able to manage own cash resources. During the course of the interviews with residents, R1 reported that facility staff is not financially abusing R1. R1 is upset because R1 no longer has access to the bank account and reported that the friend manages R1’s money. R1 reported that his friend manages his money and stated that his friend is his trustee. During the course of the interviews with witnesses, Witness 1 (W1) reported that R1 was denied access to R1 funds by the bank because
CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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 4

Control Number 22-AS-20240206120108

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ANGELS CARE GUEST HOME	FACILITY NUMBER: 306005476
	VISIT DATE: 06/20/2024

NARRATIVE

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R1’s Primary Care Physician (PCP) indicated on the last physician report that R1 requires assistance when managing own cash resources. Per W1 there is no proof that Staff 1 (S1) demanded R1 to withdraw $20, 000 and place it in another account. W1 has stated that a few months ago R1 was given a $500 visa gift card. W1 confirmed the visa gift card did not indicate that S1 used the gift card for S1 personal use.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to insufficient evidence. Therefore, the allegation has been deemed to be UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with Licensee Cruz, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
02/06/2024 and conducted by Evaluator Alvaro Ramirez Jr.

COMPLAINT CONTROL NUMBER: 22-AS-20240206120108

FACILITY NAME:	ANGELS CARE GUEST HOME		FACILITY NUMBER:	306005476
ADMINISTRATOR:	JABONERO, JANICE		FACILITY TYPE:	740
ADDRESS:	10212 MALINDA LANE		TELEPHONE:	(714) 244-5885
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92840
CAPACITY:	6	CENSUS: 6	DATE:	06/20/2024
		UNANNOUNCED	TIME BEGAN:	02:29 PM
MET WITH:	Ruby Cruz-Licensee		TIME COMPLETED:	04:31 PM

ALLEGATION(S):

1
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9

Facility staff is displaying inappropriate behavior towards resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on February 06, 2024. LPA was greeted and granted entry into the facility and met with Licensee Ruby Cruz. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that facility staff is displaying inappropriate behavior towards resident. Resident 1 (R1) was admitted to the facility on August 30, 2023. Documents reviewed included the Physician Report (LIC602) dated August 30, 2023 for R1. Per Physician report R1’s diagnoses is malignant neoplasm of left kidney. During the course of the interviews with residents, Resident 1 (R1) reported that Staff 1 (S1) was nice, attentive and respectful. Per R1 S1 assisted him by taking him on outings and/or to places he wanted to go eat. R1 reported that S1 did not displayed inappropriate behavior towards him. During the course of the interviews with witnesses, Witness 1 (W1) reported that she provided a gift card to R1 so that S1 could take R1 on outings.
CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20240206120108

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ANGELS CARE GUEST HOME	FACILITY NUMBER: 306005476
	VISIT DATE: 06/20/2024

NARRATIVE

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Per W1 R1 is happy with the company of S1. During the course of the interviews, AD stated that S1 did not displayed inappropriate behaviors towards R1. Per AD staff are respectful.

LPA Ramirez conducted an exit interview with Licensee Cruz, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

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