306005642-8-2-2022-22-AS-AORZ-CHEMQX-20220818094926

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005642
Report Date: 08/02/2022
Date Signed: 08/02/2022 11:19:25 AM

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
06/08/2022 and conducted by Evaluator Andrea Mendivil

COMPLAINT CONTROL NUMBER: 22-AS-20220608142524

FACILITY NAME:	CROWN COVE		FACILITY NUMBER:	306005642
ADMINISTRATOR:	KAMESHI TAYLOR		FACILITY TYPE:	740
ADDRESS:	3901 EAST COAST HIGHWAY		TELEPHONE:	(949) 760-2800
CITY:	CORONA DEL MAR	STATE: CA	ZIP CODE:	92625
CAPACITY:	97	CENSUS: 33	DATE:	08/02/2022
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Kameshi Taylor- Executive		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Insufficient staffing to meet resident needs
Staff do not meet resident's toileting needs
Staff do not provide a safe environment for residents.
Residents are not served nutritious meals

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility by Kameshi Taylor, Executive Director, and explained the reason for the visit.

During the course of the investigation, the Department interviewed staff, residents and witnesses as well as reviewed and obtained pertinent documentation such as staff schedules, staffing agency invoices and 5 weeks’ worth of menus. Regarding the allegations insufficient staffing to meet resident needs, staff do not meet resident’s toileting needs, staff do not provide a safe environment for residents and residents are not served nutritious meals, the investigation revealed the following:

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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-20220608142524

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: CROWN COVE	FACILITY NUMBER: 306005642
	VISIT DATE: 08/02/2022

NARRATIVE

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Based on interviews 4 out of 5 residents interviewed residents reported the staff is meeting all their needs and feel taken care of. Interviews with 4 out of 5 residents reported they felt safe at the facility. Interviews with 4 out of 5 residents indicated they liked the food provided at facility. The 5^th resident, Resident 5 (R5) was unable to be qualified due to not oriented to time and space. R5’s family present at time of interview and indicated staff checks on R5 at all times of the night and no issues with the facility.

Based on interviews with staff, 5 out of 6 denied not meeting resident’s needs, toileting needs and safety. The 6^th staff, Staff 6 (S6) member was only asked about food at facility. Interviews with 2 out of 6 staff reported food is of good quality, as only 2 staff members were directly questioned about food quality.

Therefore based on the preponderance of evidence gathered, interviews conducted, records reviewed and observations made the allegations insufficient staffing to meet resident needs, staff do no meet resident’s toileting needs, staff do not provide a safe environment for residents and residents are not served nutritious meals are all determined to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint and an exit interview was conducted with Kameshi Taylor, Executive Director and a copy of this report and LIC 811 was provided at the time of exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

LIC9099 (FAS) - (06/04)

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