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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005770
Report Date: 03/23/2023
Date Signed: 03/23/2023 11:58:16 AM

Substantiated


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
03/08/2023 and conducted by Evaluator Kimberly Lyman
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230308111217
FACILITY NAME:CASA AMOROSA/LA REINAFACILITY NUMBER:
306005770
ADMINISTRATOR:ROJAS, NADINEFACILITY TYPE:
735
ADDRESS:509 N LA REINA STTELEPHONE:
(714) 723-0264
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:4CENSUS: 3DATE:
03/23/2023
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Nadine Lozano and Jorge LozanoTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Facility is not allowing client to enter the facility after his work shift
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to the facility. LPA rang doorbell with no answer. LPA contacted Administrator by phone who stated would arrive shortly.

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility by Administrator Nadine Lozano and explained the reason for the visit. Staff Jorge Lozano was present as well.
During the course of the investigation, LPA interviewed staff, witness and client as well as reviewed and obtained pertinent documentation such as Individual Program Plan. Regarding the allegation that facility is not allowing client to enter the facility after his work shift, the investigation revealed the following: Client 1 has been employed at Disneyland since approximately January 2023 working an evening shift which ends around 10:30/ 11 PM. Facility curfew is 10:00 PM. C1 works 2-3 evenings a week and goes to client's mother's house after work. Five out of five witnesses indicated facility initiated a discussion with the Client and client's family regarding the client going to the client's mother's house after CONTINUED ON LIC 9099C DATED 03/23/2023
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
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 3
Control Number 22-AS-20230308111217
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: CASA AMOROSA/LA REINA
FACILITY NUMBER: 306005770
VISIT DATE: 03/23/2023
NARRATIVE
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work due to the facility curfew of 10:00 PM. Three out of three witnesses interviewed confirm being told client was unable to return home after work due to the curfew. Client confirms going to mother's house after work and then arriving at the facility the next morning. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted with facility representative and a copy of this report was provided as well as appeal rights.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20230308111217
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: CASA AMOROSA/LA REINA
FACILITY NUMBER: 306005770
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/24/2023
Section Cited
CCR
80072(a)(3)
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Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: To be free from unusual punishment,..including but not limited to: interference with the daily living functions.. withholding of shelter. This req is not being met as evidenced by:
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Licensee to forward a statement of understanding of the regulation to LPA by POC due date.
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Based on interviews conducted, Licensee failed to ensure C1's personal right's are being met regarding interference with daily living functions. Facility is having client go to family member's home after work due to facility curfew. This poses an immediate personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3