306005513-5-17-2023-22-AS-AORZ-CTTPZ4-20230717114454

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005513
Report Date: 05/17/2023
Date Signed: 05/17/2023 05:31:23 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
02/22/2023 and conducted by Evaluator Rosie Quiroz

COMPLAINT CONTROL NUMBER: 22-AS-20230222134942

FACILITY NAME:	CARMEL VILLAGE RETIREMENT COMMUNITY		FACILITY NUMBER:	306005513
ADMINISTRATOR:	CHARLES J EUSEY III		FACILITY TYPE:	740
ADDRESS:	17077 SAN MATEO		TELEPHONE:	(714) 962-6667
CITY:	FOUNTAIN VALLEY	STATE: CA	ZIP CODE:	92708
CAPACITY:	220	CENSUS:	DATE:	05/17/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Charles Eusey, Administrator and Laura Sanchez, Health and Wellness Director		TIME COMPLETED:	10:17 AM

ALLEGATION(S):

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-Facility elevator is not accessible to residents due to being in disrepair

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz and Licensing Program Manager (LPM ) Alisa Ortiz made an unannounced visit for the purpose to deliver findings for complaint allegation listed above. LPA Quiroz and LPM Ortiz were greeted and met with Executive Director (ED) Charles Eusey and discussed purpose of today's visit.
Regarding the allegation "Facility elevator is not accessible to residents due to being in disrepair," investigation revealed the following: On 2/2/2023 the department received written notice from the facility notifying all parties of planned elevator repair to elevator in Building #1. The repairs were set to commence on 2/13/2023 and were to be completed within 6 week timeframe. The facility implemented no tray charges for residents located on the second and third floor and provided escorting to residents who required assistance utilizing the stairs during the repairs. Snacks were provided to the residents on the second and third floor. Interviews conducted with three of three residents and facility maintenance director confirmed that residents and responsible parties had received the written notice from the facility regarding elevator repair planning.
CONTINUED...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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-20230222134942

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: CARMEL VILLAGE RETIREMENT COMMUNITY	FACILITY NUMBER: 306005513
	VISIT DATE: 05/17/2023

NARRATIVE

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CONTINUED...During LPA Quiroz's facility inspection conducted on 3/1/2023, LPA observed repairs being conducted by contracted elevator repair company. The facility retained two operational elevators during the time of repair in Building #1.

Therefore based on the preponderance of evidence through interviews and observations conducted by LPA Quiroz, the allegation that the "Facility elevator is not accessible to residents due to being in disrepair" is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint.

No deficiencies cited during today's visit.

An exit interview was conducted with Administrator Charles Eusey and Health and Wellness Director Laura Sanchez and a copy of report was provided.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC9099 (FAS) - (06/04)

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