306005778-4-28-2023-22-AS-SSAS-CREPRE-20230501113235

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005778
Report Date: 04/28/2023
Date Signed: 04/28/2023 03:55:09 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
04/26/2023 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230426111507

FACILITY NAME:	ANNISSA GEM CARE		FACILITY NUMBER:	306005778
ADMINISTRATOR:	LIMPIADO, GIDEON		FACILITY TYPE:	740
ADDRESS:	825 LILAC DRIVE		TELEPHONE:	(714) 203-1702
CITY:	PLACENTIA	STATE: CA	ZIP CODE:	92870
CAPACITY:	6	CENSUS: 6	DATE:	04/28/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Karmian Calangi		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility staff abuses resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose to conduct a complaint investigation into the above allegation. LPA was greeted and granted entry by House Manager (HM) Anthony de Guzman. LPA observed three staff on duty and six residents in care. At 1:35pm, LPA notified Administrator (Admin) Karmian Calangi by telephone and arrived shortly after. During the course of the investigation, LPA interviewed residents, staff, and Administrator. Copies of records were obtained and reviewed for all registered residents, and the following was determined:

It was alleged that the facility staff abuses resident in care. LPA observed the residents resting in the living room or bedroom. LPA observed that the interactions between staff and residents were professional and courteous. Five out of the six residents stated that they were treated well and did not have any concerns. One of six residents could not be interviewed due to their diagnosis. Interviews with three out of three staff whom have indicated that they have not abused nor witnessed an abuse to a resident.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

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-20230426111507

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: ANNISSA GEM CARE	FACILITY NUMBER: 306005778
	VISIT DATE: 04/28/2023

NARRATIVE

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Therefore, this agency has investigated the complaint. Based on the observations made, interviews, and the records reviewed, the above allegation is deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Administrator Karmian Calangi, and a copy of this report was provided during the visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC9099 (FAS) - (06/04)

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