306005712-3-21-2023-22-AS-SSAS-CQ6PPD-20230322112919

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005712
Report Date: 03/21/2023
Date Signed: 03/21/2023 02:57:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
03/15/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230315093506

FACILITY NAME:	VARGAS HOME		FACILITY NUMBER:	306005712
ADMINISTRATOR:	MORA, ANA		FACILITY TYPE:	735
ADDRESS:	2814 WAVERLY AVE		TELEPHONE:	(714) 602-7593
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92705
CAPACITY:	6	CENSUS: 5	DATE:	03/21/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Ana Mora, Administrator Hugo Mora, caregiver		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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1/ Facility is not properly staffed to meet the needs of the clients.

INVESTIGATION FINDINGS:

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On ths day, Licensing ProgramAnalyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of investigating the allegations listed above. LPA was greeted and granted entry by Administrator Ana Mora after explaining the purpose of the visit and detailing the allegations.

LPA accompanied by adminstrator conducted a tour of the physical plant. There are currently 5 clients residing in two shared rooms and one single bedrooms at the time of the visit.

LPA requested, obtained and reviewed staff records for staff members S1, S2 and S3. Staff records were observed to include all necessary documents. Training and first aid certification are up to date for all three staff files reviewed. Administrator was working on documenting the staff schedule for the three individuals stated to be actively working at the facility and provided LPA with a copy of the current schedule.

CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

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-20230315093506

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: VARGAS HOME	FACILITY NUMBER: 306005712
	VISIT DATE: 03/21/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099

LPA additionally requested, obtained and reviewed files for all five current clients. LPA confirmed that the clients required level of care matches the administrator's statement. All five clients require minimal assistance, essentially with activities of daily living such as management of cash resources and medication administration but are independently managing all other activities.

An interview was conducted with the facility administrator during the visit.

Regarding the allegation that Facility is not properly staffed to meet the needs of the clients, the following has been concluded: Based on the provisional schedule provided by administrator, interview with administrator, review of staff records and observation conducted in the facility, LPA was able to confirm that continued care and supervision for the individuals in care was being adequately provided. Administrator stated issues with hiring additional staff, however, due to the minimal level of assistance verified to be required by all five clients, it appears clients' needs are being adequately addressed at the current staffing level.

The allegation that Facility is not properly staffed to meet the needs of the clients is therefore deemed Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and a copy of this report was provided to facility representative.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023

LIC9099 (FAS) - (06/04)

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