306005680-3-1-2024-22-AS-AORZ-D39JUN-20240311072147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005680
Report Date: 03/01/2024
Date Signed: 03/01/2024 12:44:20 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
02/28/2024 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20240228122029

FACILITY NAME:	CARNELIAN VILLAS		FACILITY NUMBER:	306005680
ADMINISTRATOR:	STRUVE, JING		FACILITY TYPE:	740
ADDRESS:	1773 S. CARNELIAN STREET		TELEPHONE:	(714) 860-4490
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92802
CAPACITY:	6	CENSUS: 5	DATE:	03/01/2024
		UNANNOUNCED	TIME BEGAN:	11:13 AM
MET WITH:	Richard Robles and Cherie Wood		TIME COMPLETED:	01:08 PM

ALLEGATION(S):

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Facility staff are not background cleared

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. Administrator Cherie Wood arrived during the visit.

During the visit, LPA toured the facility and interviewed staff as well as reviewed staff files. Regarding the allegation that facility staff are not background cleared, the investigation revealed the following: There are two staff present during today's visit. LPA reviewed staff files, criminal record clearances and LIC 500. All staff working at the facility are documented to be fingerprint cleared and associated to the facility.

Based on record review, the allegation is deemed unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024

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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