306005633-10-17-2023-22-AS-SSAS-CX52JL-20231030172630

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005633
Report Date: 10/17/2023
Date Signed: 10/17/2023 04:20:03 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
09/08/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230908155926

FACILITY NAME:	MARYKNOLL SENIOR CARE		FACILITY NUMBER:	306005633
ADMINISTRATOR:	UMALI, FRANCES AMANDA		FACILITY TYPE:	740
ADDRESS:	531 WHITTEN WAY		TELEPHONE:	(805) 836-1556
CITY:	PLACENTIA	STATE: CA	ZIP CODE:	92870
CAPACITY:	6	CENSUS: 5	DATE:	10/17/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Amanda Umali, Administrator (via phone)		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Staff do not treat resident(s) in care with dignity.

Staff do not ensure that resident(s) in care are provided with a sufficient amount of food.

Staff discriminate against resident(s) 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 three allegations listed. LPA was greeted and granted entry by facility staff after explaining the reason for the visit. Facility administrator Amanda Umali was notified of the visit by telephone and read the report.

An initial complaint investigation visit was conducted on September 13, 2023. LPA conducted or attempted interviews with the four residents present at the facility at the time of the visit. Resident records were requested, obtained and reviewed at the facility. A tour of the physical plant was conducted in the company of one of the three caregivers present. Two staff members including facility administrator were additionally interviewed during the visit. Additional witness interviews were later conducted by telephone.

CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

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-20230908155926

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: MARYKNOLL SENIOR CARE	FACILITY NUMBER: 306005633
	VISIT DATE: 10/17/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099

Regarding the allegation that Staff do not treat resident(s) in care with dignity, the following has been concluded: Based on observation and interviews with residents and witnesses, no personal rights concerns could be evidenced to be ongoing in the treatment of residents by staff members.

Regarding the allegation that Staff do not ensure that resident(s) in care are provided with a sufficient amount of food, the following has been concluded: Based on the meals observed, meal plans and menus reviewed along with interviews with staff, residents and various witnesses, no evidence corroborating the fact that insufficient nutrition is being provided could be found.

Finally, regarding the allegation that Staff discriminate against resident(s) in care, the following has been concluded: The residents and witnesses interviewed during the course of the investigation did not confirm any observed or perceived discrimination based on age or sex as alleged in the initial complaint. However, due to the absence of certain residents or impossibility to conduct some interviews, discrimination cannot be ruled out altogether.

As a result, the allegations are 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 by telephone and a copy of this report was provided after administrator gace permission to caregiving staff to sign on her behalf.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

LIC9099 (FAS) - (06/04)

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