306005737-10-20-2022-22-AS-AORZ-CKJUQU-20221025154743

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005737
Report Date: 10/20/2022
Date Signed: 10/20/2022 07:29:51 AM

Unsubstantiated

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
12/01/2020 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20201201153105

FACILITY NAME:	GENUINECARE RESIDENTIAL CARE FACILITY		FACILITY NUMBER:	306005737
ADMINISTRATOR:	MANLULU, HELBERT B		FACILITY TYPE:	740
ADDRESS:	1904 W. RANDOM DRIVE		TELEPHONE:	(714) 603-7830
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	0	CENSUS:	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	07:27 AM
MET WITH:			TIME COMPLETED:	07:30 AM

ALLEGATION(S):

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Licensee did not assist resident with incontinence care
Licensee did not provide resident with basic care services
Inadequate food service

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman delivered findings via telephone voicemail and emailed report to former licensee, Erika Manlulu. Facility has been closed since 03/11/2020.

During the course of the investigation, the department interviewed Administrator Thanh Trieu as well as conducted a FaceTime visit due to covid restrictions. At time of interview on 12/08/2020, Administrator stated there were no residents living at the facility. Administrator denied inadequate food service as well as not providing incontinence care or basic services to residents. LPA Lyman attempted to contact staff who had been employed at time of complaint but had no success. Staff either have left the country or are unreachable with no contact information. Due to insuffcient information, LPA is unable to corroborate the allegation. Therefore, the allegations are 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. A copy of this report was provided via email to former licensee.

Unsubstantiated

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: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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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