306005543-10-23-2023-22-AS-SSAS-CX4UF5-20231030153208

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005543
Report Date: 10/23/2023
Date Signed: 10/23/2023 03:36:59 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
08/20/2020 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200820134813

FACILITY NAME:	D'AMORE HEALTHCARE - S RENE		FACILITY NUMBER:	306005543
ADMINISTRATOR:	MEGHAN WHEELER		FACILITY TYPE:	772
ADDRESS:	2902 S RENE DR		TELEPHONE:	(714) 375-1110
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY:	6	CENSUS: 5	DATE:	10/23/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Benjamin Smith, Chief Administrative Officer (via telephone)		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff failed to administer client's medication

Client sustained injury while in care

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the two allegations listed above. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit.

An initial investigation visit was conducted on August 20, 2020 by LPA Lydia Martinez. The visit was led virtually per Department's COVID-19 guidelines in effect at the time. Following a telephone follow-up on May 13, 2022, LPA obtained client records for client C1 for the complaint file.

Two follow-up visits were later conducted on September 14 and September 21, 2023. Additional staff interviews conducted as well as a review of available records.

CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

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-20200820134813

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: D'AMORE HEALTHCARE - S RENE	FACILITY NUMBER: 306005543
	VISIT DATE: 10/23/2023

NARRATIVE

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CONTINUED FROM LIC9099

Regarding the allegation that Facility staff failed to administer client's medication, the following has been concluded: Based on interviews conducted and records reviewed, there is evidence of multiple disagreements between facility staff and client C1 on the topic of medication, eventually leading to the client's administrative discharge before the completion of the facility's program. The Medication Administration Records are however found to be complete and do not evidence any failure to provide medication in accordance with the prescription orders on file. There is insufficient evidence to demonstrate that C1 did not receive time-sensitive medication outside of the prescribed window. As a result, the allegation is found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Regarding the allegation that Client sustained injury while in care, the following has been concluded: While interviews and records reviewed establish the occurrence of a physical altercation between C1 and another facility client on May 4, 2020, it could not be confirmed that the altercation was the result of a failure of the facility to provide adequate care and supervision. Additionally, the medical records obtained during the present investigation did not corroborate that the altercation caused significant injury to client C1 either. The allegation is therefore found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and a signed copy of this report was provided to a facility representative.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

LIC9099 (FAS) - (06/04)

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