306005500-5-1-2023-22-AS-SSAS-CRUW52-20230515165820

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005500
Report Date: 05/01/2023
Date Signed: 05/01/2023 02:29:23 PM

Unfounded

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
04/27/2023 and conducted by Evaluator Jerome Haley

COMPLAINT CONTROL NUMBER: 22-AS-20230427090922

FACILITY NAME:	CARE JULIET 1		FACILITY NUMBER:	306005500
ADMINISTRATOR:	DEL ROSARIO, LESTER		FACILITY TYPE:	740
ADDRESS:	479 S WELLINGTON RD		TELEPHONE:	(209) 914-1153
CITY:	ORANGE	STATE: CA	ZIP CODE:	92869
CAPACITY:	6	CENSUS: 6	DATE:	05/01/2023
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Administrator John Del Rosario		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff failed to provide a safe and comfortable environment for residents
Staff are unable to communicate with residents due to language barrier

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made an unannounced initial 10-day visit regarding the complaint allegations listed above. LPA identified himself and explained the reason for the visit with staff who called Administraotr (AD) John Del Rosario via telephone who arrived a short time later. Before interviewing residents and staff to gather details, LPA Haley toured the interior and exterior of the facility with Staff 1 (S1).

Regarding the allegations, “Staff failed to provide a safe and comfortable environment for residents” The investigation revealed the following:

During the initial visit May 1, 2023, LPA Haley toured the facility and observed all six residents in care. The facility was observed to be clean and well organized. During the visit LPA Haley interviewed AD Del Rosario, two staff, and four residents. 4 of 4 reisdents interviewed denied the allegation above. 2 of 2 staff and AD Del Rosario denied the allegation above.

Continued on LIC9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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-20230427090922

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: CARE JULIET 1	FACILITY NUMBER: 306005500
	VISIT DATE: 05/01/2023

NARRATIVE

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Regarding the allegations, “Staff are unable to communicate with residents due to language barrier” The investigation revealed the following:

During the visit, LPA Haley conducted interviews with AD Del Rosario, and both staff member in English without any communication issues noted during the visit or interviews. 4 of 4 residents interviewed during the visit denied the allegation above. AD Del Rosario denied the allegation and both staff members denied the allegation as well.

Based on the information gathered during the investigation, observation, and review of all documents obtained, the following allegations: "Staff failed to provide a safe and comfortable environment for residents", and "Staff are unable to communicate with residents due to language barrier" is deemed Unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

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

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

LIC9099 (FAS) - (06/04)

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