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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005518
Report Date: 05/06/2025
Date Signed: 07/15/2025 10:05:17 AM

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
04/28/2025 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250428132935
FACILITY NAME:JANEEN HOMEFACILITY NUMBER:
306005518
ADMINISTRATOR:JESSICA GARCIAFACILITY TYPE:
734
ADDRESS:1438 W JANEEN WAYTELEPHONE:
(657) 254-0274
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:5CENSUS: 4DATE:
05/06/2025
UNANNOUNCEDTIME BEGAN:
07:53 AM
MET WITH:Jessica Garcia - Administrator TIME COMPLETED:
10:35 AM
ALLEGATION(S):
1
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9
A lack of supervision resulted in client falling multiple times.
Facility failed to report fall incidents.
INVESTIGATION FINDINGS:
1
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9
10
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13
On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unnannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility and explained the reason for the visit.
The Department received a complaint on 04/28/2025 and the initial 10 day visit was conducted on 05/06/2025. LPA Mendivil interviewed staff and obtained copies of documents such as Individual Program Plan, physician's report and staff schedules . Regarding the allegations a lack of supervision resulted in client falling multiple times and facility failed to report fall incidents the investigation revealed the following:
It was alleged that multiple falls occurred on 04/24/2025 for Client 1. Based on interviews with 4 out of 4 staff reported there were zero falls for any clients for the week of 04/21/2025 to 04/26/2025. Administrator Jessica Garcia stated if there is a reported fall facility will call 911 and then report to both Regional Center of Orange County (RCOC) and Community Care Licensing Division (CCLD).


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
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-20250428132935
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: JANEEN HOME
FACILITY NUMBER: 306005518
VISIT DATE: 05/06/2025
NARRATIVE
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Due to no evidence of a fall that took place the week of 04/21- 04/26 the facility would not have sent in a report regarding falls.

Therefore based on the preponderance of evidence through interviews the allegations that a lack of supervision resulted in client falling multiple times and facility failed to report fall incidents are determined to be UNSUBSTANTIATED meaning although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

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

Report amended due to technical error
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2