306005737-10-20-2022-22-AS-AORZ-CKJUQD-20221025154658

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005737
Report Date: 10/20/2022
Date Signed: 10/20/2022 07:43:57 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
01/29/2021 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20210129112337

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:	07:43 AM
MET WITH:			TIME COMPLETED:	07:45 AM

ALLEGATION(S):

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Resident administering medications to another resident.
Medications are accessible to resident's.
Resident's hygiene needs are not being met.
Facility is unsanitary.
Staff did not ensure resident's room was clean.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman delivered findings verbally 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, LPA interviewed Administrator as well as reviewed and obtained pertinent documentation such as physician report and appraisal needs and services. Regarding the allegations that resident administering medications to another resident, medications are accessible to resident's, resident's hygiene needs are not being met, facility is unsanitary and staff did not ensure resident's room was clean, the investigation revealed the following: Per interview with Administrator, Administrator denies all allegations. LPA is unable to contact prior facility staff due to lack of contact information. Witness is unable to provide resident's current location. 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.

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: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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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