306005694-1-24-2025-22-AS-AORZ-DDEUBA-20250130142603

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005694
Report Date: 11/06/2024
Date Signed: 01/24/2025 02:21:59 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
11/04/2024 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20241104100155

FACILITY NAME:	DEL'S HAVEN		FACILITY NUMBER:	306005694
ADMINISTRATOR:	MANALO, DIANNA		FACILITY TYPE:	740
ADDRESS:	29835 ANDREA WAY		TELEPHONE:	(949) 418-3222
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY:	6	CENSUS: 5	DATE:	11/06/2024
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Dianna Manalo		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility staff are not following resident's dietary needs
Facility staff are not adhering to infection control requirements

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit on January 24, 2025 at 1:30pm to deliver the amended complaint report. The findings of the original report have not changed. LPA met with Administrator Dianna Manalo and explained the reason for the visit. The investigation revealed the following. It was alleged that the facility staff are not following resident's dietary needs. LPA interviewed staff. Resident 1 (R1) was at a medical appointment and could not be interviewed. A review of R1's records shows that R1 has been diagnosed with Diabetes and Renal failure. R1 is on dialysis. R1's physician has prescribed a special diet for R1. The Administrator reported that they are following the physician's orders. The Administrator reported they received a list of suggested foods for people on dialysis from the dialysis center where R1 goes. LPA reviewed the facility's menu and it coincides with suggested list of foods for people on dialysis. LPA observed the facility has items in the kitchen such as, spaghetti, carrots, mixed vegetables, Cream of wheat and eggs which were recommended to the facility to provide to R1, from the dialysis center. The Administrator reported that they are following the guidelines from the dialysis center for R1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

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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Control Number 22-AS-20241104100155

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: DEL'S HAVEN	FACILITY NUMBER: 306005694
	VISIT DATE: 11/06/2024

NARRATIVE

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R1 was prescribed a special diet by their physician as noted on their physician’s report. California code of regulation (CCR) 87555(b)(7) states, "Modified diets prescribed by a resident's physician as a medical necessity shall be provided.". The facility is providing the prescribed special diet which also complies with the dietary guidelines recommended by the dialysis center. Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, facility staff are not adhering to infection control requirements, revealed the following. It was alleged residents at the facility were ill and the facility failed to implement infection control requirements such as staff wearing masks. LPA interviewed the Administrator, staff and 3 out of 5 residents. 1 resident did not want to be interviewed and the other resident was not present at the facility. 3 out of 5 residents reported they were not ill and are feeling good. Staff reported that all residents cough or sneeze each day but no one reported they were not feeling well and no one is sick. The Administrator reported that none of the residents have been to the doctor recently or diagnosed with any illness. LPA reviewed resident records, there is no recent diagnosis of a contagious disease for any resident. No staff or residents have reported any illness at the facility. At this time because there is no diagnosis of a contagious disease, staff are not required to wear a mask. Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and a copy of the amended report provided. The report was amended to reflect a change in verbiage for the first allegation only.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC9099 (FAS) - (06/04)

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