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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005682
Report Date: 05/09/2024
Date Signed: 05/09/2024 07:04:01 PM

Substantiated


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
02/14/2024 and conducted by Evaluator Celine DePerio
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240214151712
FACILITY NAME:JEAN'S HOUSEFACILITY NUMBER:
306005682
ADMINISTRATOR:GILBERT MARQUEZFACILITY TYPE:
735
ADDRESS:14741 HOLT AVETELEPHONE:
(714) 923-1221
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:4CENSUS: 4DATE:
05/09/2024
UNANNOUNCEDTIME BEGAN:
05:13 PM
MET WITH:Community Care Director-James RockeTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Residents are being left alone at facility by staff
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted, and granted entry by Community Care Director (CCD) - James Rocke.

It was alleged residents are being left alone at facility by staff. 1 out of 1 interview conducted with staff provided an admission that there were no staff members who arrived for their shift. 4 out of 4 client interviews corroborated with the allegation by verifying that there were two days in February where the scheduled night staff did not arrive for their shift. LPA De Perio conducted a record review of the night staff schedule and clock-ins. It was observed that on February 9, 2024, from 9:30PM-6:30AM and February 11, 2024 from 8:33PM-6:30AM there were no staff present, nor clocked in for their shift.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, the preponderance of evidence standard has been met, therefore the allegation is SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
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 3
Control Number 22-AS-20240214151712
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: JEAN'S HOUSE
FACILITY NUMBER: 306005682
VISIT DATE: 05/09/2024
NARRATIVE
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An exit interview was conducted with CDD Rocke.

A copy of this report was explained, and appeal rights were provided during the visit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20240214151712
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: JEAN'S HOUSE
FACILITY NUMBER: 306005682
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2024
Section Cited
CCR
85065.6(a)
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85065.6 Night Supervision
(a) Night supervisory staff shall meet the personnel requirements specified in Section 80065, and the requirements below.
This requirement is not met as evidence by:
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As a plan of correction of (POC), administrator will read the regulation, and provide proof of understanding to LPA on or by 5/9/24.
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Based on LPAs observations, interviews, and review of documents obtained, on 2/9/24, from 9:30PM-6:30AM and 2/11/24, from 8:33PM-6:30AM there were no staff present, nor clocked in for their shift. This poses an immediate health and safety to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC9099 (FAS) - (06/04)
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