306005672-7-12-2022-22-AS-MVAO-CHUT9M-20220901143211

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005672
Report Date: 07/12/2022
Date Signed: 07/12/2022 11:36:57 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
06/30/2022 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220630150110

FACILITY NAME:	WELLINGTON, THE		FACILITY NUMBER:	306005672
ADMINISTRATOR:	HILES, LINDA		FACILITY TYPE:	740
ADDRESS:	24903 MOULTON PARKWAY		TELEPHONE:	(949) 458-2311
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	160	CENSUS: 129	DATE:	07/12/2022
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Jennifer Ortega, Business Office Director		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Facility failed to provide resident proper care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegation. LPA arrive at facility was greeted by receptionist and granted entry. LPA spoke with Jennifer Ortega, Business Office Director and explained the purpose of the visit.

During the course of the investigation, interview was conducted with staff, a review of resident records was completed and copy of pertinent documents obtained.

Based on the information obtained during this visit the department has concluded the investigation into the above mentioned allegation. Findings are based upon this investigation which include resident file review

Continued on LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

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 2

Control Number 22-AS-20220630150110

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: WELLINGTON, THE	FACILITY NUMBER: 306005672
	VISIT DATE: 07/12/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

and interview with staff. It is alleged that facility failed to provide residents proper care. Based on the information on file for the facility R1 resides in the independent living side and it is not covered under CCLD licensure for the facility.

Therefore, the Department has determined the complaint to be unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. The Department has therefore dismissed the complaint.

A copy of this report is being reviewed with facility representative and a copy of this LIC9099 was furnished to the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2