306005566-3-5-2024-22-AS-LMOA-D3NPMB-20240324112600

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005566
Report Date: 03/05/2024
Date Signed: 03/05/2024 11:36:04 AM

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
11/13/2023 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231113161547

FACILITY NAME:	A1 RCFE @ DELPHINE		FACILITY NUMBER:	306005566
ADMINISTRATOR:	VILLARMINO, SHIRLEY		FACILITY TYPE:	740
ADDRESS:	923 HUGGINS AVE		TELEPHONE:	(714) 399-5040
CITY:	PLACENTIA	STATE: CA	ZIP CODE:	92870
CAPACITY:	6	CENSUS: 5	DATE:	03/05/2024
		UNANNOUNCED	TIME BEGAN:	09:11 AM
MET WITH:	Administrator Shirley Villarmino and Caregiver Mary Ann Ednalig		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff are sleeping in residents’ room.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre met with Administrator Shirley Villarmino for the purpose of delivering findings for the above allegations. The investigation consisted of Observations and interviews with staff & residents.

On 11/13/2023 the department received allegations that staff are sleeping in residents’ room. The investigation was completed by the department and revealed the following:
Based on interviews, Four of four staff interviewed stated that residents sleep in their own bedrooms and that facility has staff bedroom located upstairs. Interviews with staff revealed that there is one live in staff who occupies staff bedroom. Four of four staff confirmed that no staff are sleeping in residents rooms.
Resident interviews revealed that three of three residents interviewed confirm they like care they are receiving at facility and get along with facility staff. Interviews with residents reveal that three of three residents confirmed no staff are sleeping in resident rooms.
CONTINUED ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

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-20231113161547

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: A1 RCFE @ DELPHINE	FACILITY NUMBER: 306005566
	VISIT DATE: 03/05/2024

NARRATIVE

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During inspection visits it was observed facility has four resident rooms two that are private and two shared. During visits no observations of additional beds or bedding in resident rooms or closets. LPA observed a large closet space between one bedroom and bathroom. LPA observed closet space is being used for storage. During visit LPA observed Durable Medical Equipment such as wheelchairs, under pads, and diapers being stored inside closet space. Observations revealed all residents have closets or storage cabinets for clothing and personal belongings located inside each resident room.

Therefore, based on interviews conducted and observations made, the allegation staff are sleeping in residents room is deemed UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

During Visit Administrator Villarmino had to leave and consented Caregiver Mary Ann Ednalig to sign report on behalf. An exit interview was conducted with staff, and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer Tirre	TELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

LIC9099 (FAS) - (06/04)

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