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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005719
Report Date: 01/12/2024
Date Signed: 01/12/2024 04:43:03 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
10/18/2021 and conducted by Evaluator Rosie Quiroz
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211018132324
FACILITY NAME:TRUCARE BOARDING HOME INC.FACILITY NUMBER:
306005719
ADMINISTRATOR:QUY, NATHANFACILITY TYPE:
740
ADDRESS:9367 SISKIN AVETELEPHONE:
(626) 382-9357
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:0CENSUS: 0DATE:
01/12/2024
UNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Nathan Quy, Licensee/Administrator "Via Telephone"TIME COMPLETED:
04:41 PM
ALLEGATION(S):
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-Resident sustained unexplained injuries while in care
-Food service is not adequate
INVESTIGATION FINDINGS:
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 On today's date, Licensing Program Analyst (LPA) Rosie Quiroz called and spoke to Licensee/Administrator (L/AD) Nathan Quy and discussed purpose of today’s telephone call to deliver findings for allegations listed above.
LPA Quiroz conducted the 10 day visit on 10/28/2021. During the course of the investigation, LPA Quiroz conducted interviews with interviewees consisting of staff and residents and reviewed documentation but not limited to physician reports, needs and services plans, staff roster, resident roster, and Special Incident Report (SIR) received in the Orange County Regional Office dated 2/12/2021.
Regarding the allegation: "Resident sustained unexplained injuries while in care,” the investigation revealed the following: Five of five interviewees denied the allegation. During Facility inspection visit conducted on 10/28/2021 on or about 10:25am, while LPA Quiroz was reviewing documents, LPA Quiroz observed Resident 1 (R1) getting up from the chair in dinging room area walking towards the kitchen area. While R1 was walking towards the kitchen area, LPA Quiroz observed R1 state “Ouch.” LPA Quiroz observed R1 bump self on kitchen counter top. CONTINUED ON NEXT PAGE...
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
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 2
Control Number 22-AS-20211018132324
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: TRUCARE BOARDING HOME INC.
FACILITY NUMBER: 306005719
VISIT DATE: 01/12/2024
NARRATIVE
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CONTINUED...LPA Quiroz attempted to greet and interview R1, however R1 looked away and did not respond to LPA Quiroz’s greet. Four of Five interviewees indicated R1 tends to walk around the facility and in R1s bedroom area and not careful about bumping into furniture or other items. LPA Quiroz attempted to interview Five of six residents, however LPA Quiroz was not able to qualify Five of six residents in care due to cognitive impairment diagnoses. Resident 6 (R6) denied physical abuse while in care from staff or other residents indicating “staff are very nice and I love the healthy soups we eat here.”
Regarding the allegation: “Food service is not adequate,” the investigation revealed the following: Five of five interviewees consisting of staff and resident denied the allegation indicating current residents residing at the facility enjoy eating soups and that when served other food entrees that current residents in care are observed not to eat the food. During Facility inspection visit conducted on 10/28/2021 on or about 9:50am, while LPA Quiroz toured the kitchen area, LPA Quiroz observed adequate amount of perishable and non- perishable food items. Title 22 California Code of Regulation 87555 :General Food Service Requirements(b)(3)(5) indicate that (3)between- meal nourishment or snacks shall be made available for all residents unless limited by dietary restrictions prescribed by a physician. (5)Meals shall consist of an appropriate variety of foods and shall be planned with consideration for cultural and religious background and food habits of residents.
Based on the evidence gathered from interviews conducted, facility inspection observations, and documentation review, the allegation of "Resident sustained unexplained injuries while in care” and “Food service is not adequate” is deemed Unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis; Therefore complaint allegations are dismissed.
LPA Quiroz attempted to call (L/AD) Nathan Quy via telephone to conduct exit interview, however (L/AD) Nathan Quy did not answer. Detailed voicemail with findings and instructions to submit copy of signed report to Community Care Licensed were provided to (L/AD) Nathan Quy via voicemail. A copy of this report along with LIC 811- Confidential Names list were provided to (L/AD) Quy via email on today's date.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2