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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005552
Report Date: 06/21/2022
Date Signed: 06/21/2022 12:42:14 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
06/15/2022 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220615110522
FACILITY NAME:KAEGO'S RICHMAN GARDENS BY SERENITY CARE HEALTHFACILITY NUMBER:
306005552
ADMINISTRATOR:OGBECHIE, BIOSEHFACILITY TYPE:
740
ADDRESS:317 N RICHMAN AVETELEPHONE:
(714) 213-8248
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:26CENSUS: 10DATE:
06/21/2022
UNANNOUNCEDTIME BEGAN:
08:41 AM
MET WITH:Rosalba Maldonado, Lupe Harvey, Wendy Cruz AndradeTIME COMPLETED:
12:55 PM
ALLEGATION(S):
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Facility has pests.
Facility is not following food handling guidelines.
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegations. LPA met with Staff #1 (S1) Rosalba Maldonado, discussed the purpose of the inspection, and explained the allegations. Administrator (AD) Lupe Harvey and Facility Manager (S2) Wendy Cruz Andrade arrived during the inspection.
The investigation into the allegations that Facility has pests and Facility is not following food handling guidelines revealed the following: During the course of the investigation, LPA inspected the facility’s kitchen, dining room, common areas, and food storage areas, interviewed AD, 4 residents, and 4 staff, and requested and reviewed copies of the resident roster, staff roster, pest control records, and staff files.
LPA inspected the kitchen, dining room, common areas, and 3 additional food storage locations and observed no flies or insects of any kind. Other than the occasional fly, none of the 4 residents interviewed reported seeing any insects inside the facility or that the facility has a problem with pests. 4 out of 4 staff interviewed stated that other than the occasional fly, the facility does not have any insects inside the facility or that the facility has a problem with pests.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
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 3
Control Number 22-AS-20220615110522
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: KAEGO'S RICHMAN GARDENS BY SERENITY CARE HEALTH
FACILITY NUMBER: 306005552
VISIT DATE: 06/21/2022
NARRATIVE
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S1 stated that a pest control company regularly comes to address any insect issues and the facility has 2 fly trap light fixtures in the dining room that catch flies and that they are regularly cleaned out. LPA observed these 2 fly trap lights and confirmed S1’s statement. S2 stated that the pest control company comes every 3 months to address any insect issues and provided pest control records. LPA reviewed pest control records showing that the pest control company’s most recent visit was on 05/27/22 and lasted about an hour and half with multiple services provided.
LPA inspected the kitchen, dining room, and 3 additional food storage locations and observed they were clean and organized and were free from debris, stains, and food particles. LPA observed that AD had brought a puppy to the facility and that the puppy was kept in the office. Interviews with 3 residents and 4 staff revealed that this puppy is sometimes brought to the facility, but is never allowed into the kitchen or dining room and is kept in the office or front yard. Residents interviewed stated they enjoy playing with the puppy when it is present. 4 out of 4 residents stated the food at the facility is good, that they have no current issues at the facility, and 2 residents stated the facility and staff are “wonderful” and “great”. Interviews with 4 staff, including Staff #3 (S3) and Staff #4 (S4) who do the cooking, revealed that food prep staff always wash their hands before preparing food and wash their hands multiple times during their shift, wear gloves while preparing food, clean and sanitize the kitchen and cooking equipment after each meal is prepared (i.e., 3 or 4 times a day), and always check to ensure ingredients are fresh and in good condition before cooking. LPA observed S3 in the kitchen after breakfast had been made and observed all kitchen counters had been cleaned, the floors and counters were free of debris, stains, and food particles, all the dishes and cooking equipment had been cleaned and put away, and the sink had been cleaned and emptied of debris and food particles. Per S1 and S2, the kitchen and dining room trash bags are emptied after each meal and the trash can is cleaned of any stains or food particles. In the kitchen, LPA observed soap, paper towels, gloves, hair nets, a posted list of special diets for specific residents, a posted kitchen and dining room cleaning protocol, and cooking ingredients such as rice and oatmeal in sealed plastic containers. LPA tested the water temperature for the kitchen sink and observed it to be within limits at 110 degrees F. LPA observed thermometers in 3 refrigerators showed 40 degrees F and the thermometers in 3 freezers showed 0 or -10 degrees F. LPA observed the refrigerators and freezers were clean and free of debris, stains, and loose food particles. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA observed the facility has fresh fruit and vegetables. S1 stated that today was shopping day so additional food and fresh fruit and vegetables, as well as any additional necessary items, would be brought to the facility today.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20220615110522
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: KAEGO'S RICHMAN GARDENS BY SERENITY CARE HEALTH
FACILITY NUMBER: 306005552
VISIT DATE: 06/21/2022
NARRATIVE
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 LPA observed the facility has supplies of toiletries for residents, cleaning supplies, soap, paper towels, toilet paper, gloves, PPE, and other supplies. Per interview with S3, S3 has 30 years of experience in a facility setting including in food preparation. S4 stated they were trained by the previous cook on food preparation and food safety. LPA took photographs of all areas inspected. There were no health and safety concerns observed in the areas inspected.
The Department has investigated the above allegations and found them to be Unfounded, meaning the allegations were false, could not have happened, or are without reasonable basis. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3