306005835-5-8-2024-22-AS-SSAS-DD924L-20250124160403

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005835
Report Date: 05/08/2024
Date Signed: 05/08/2024 12:29:44 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
05/03/2024 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240503120613

FACILITY NAME:	KIRKWOOD ORANGE		FACILITY NUMBER:	306005835
ADMINISTRATOR:	ZEHRA SYED		FACILITY TYPE:	740
ADDRESS:	1525 E TAFT AVENUE		TELEPHONE:	(714) 282-1409
CITY:	ORANGE	STATE: CA	ZIP CODE:	92865
CAPACITY:	66	CENSUS: 44	DATE:	05/08/2024
		UNANNOUNCED	TIME BEGAN:	08:17 AM
MET WITH:	Executive Director- Megan Blacher		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Staff did not safeguard resident's personal items
Staff did not keep the facility free from odor (marijuana)
Staff conduct poses a risk to residents in care
Staff do not provide daily activities for residents in care
Staff did not keep the facility free from pest

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced 10-day visit to the facility for the complaint and to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted by Executive Director (ED) Megan Blacher.

During the investigation, LPA De Perio toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed.

It was alleged that staff did not safeguard resident's personal items. LPA De Perio conducted 5 resident interviews, of which 5 out of 5 resident interviews did not corroborate with the allegation by stating that staff do safeguard resident’s personal items. 2 out of 2 staff interviews conducted, also did not corroborate with the allegation by stating that personal items are kept in locked areas, if the family requests it, however, per documentation review, LPA De Perio observed that all residents and responsible parties, opted out in signing the facility document regarding in the resident’s personal inventory list.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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-20240503120613

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: KIRKWOOD ORANGE	FACILITY NUMBER: 306005835
	VISIT DATE: 05/08/2024

NARRATIVE

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It was alleged that staff did not keep the facility free from odor (marijuana). LPA De Perio conducted 5 resident interviews, of which 5 out of 5 resident interviews did not corroborate with the allegation and denied any concerns and instances related to this allegation. 2 out of 2 staff interviews conducted, also did not corroborate with the allegation by stating that there have been no issues amongst staff or residents smelling like or using marijuana. LPA De Perio conducted a tour of the physical plant of the facility and selected random resident rooms and did not observe or smell any areas of the facility having an odor from marijuana. LPA De Perio conducted documentation review and observed that staff are required to acknowledge and sign the facility handbook upon hire, acknowledging that staff are prohibited to be under the influence while on the job or company property, and that it is subject to termination. Per documentation review, there were no history of documents

It was alleged that staff conduct poses a risk to residents in care. LPA De Perio conducted 5 resident interviews, of which 5 out of 5 resident interviews did not corroborate with the allegation by stating that there were no health and safety concerns present and provided positive feedback regarding staff. 2 out of 2 staff interviews conducted, also did not corroborate with the allegation by stating that all staff undergo training regarding resident care and are not allowed to start working until completed. LPA De Perio conducted documentation review and observed that current facility management will hold meetings with staff if there were any risk concerns while providing care, and that there are ongoing trainings that are held.

It was alleged that staff do not provide daily activities for residents in care. LPA De Perio conducted 5 resident interviews, of which 5 out of 5 resident interviews did not corroborate with the allegation by stating that the facility offers activities but is voluntary for residents to attend. 2 out of 2 staff interviews conducted, also did not corroborate with the allegation by stating that activities are offered to both the assisted living and memory care areas of the facility. Upon LPA De Perio entering the facility, LPA De Perio observed that residents were actively participating in an activity led by staff, in the lobby. LPA De Perio conducted a tour of the physical plant of the facility and observed that the facility has an activity schedule posted for both the assisted living and memory care area. Per documentation review, LPA De Perio observed that the facility activities scheduled daily for residents.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20240503120613

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: KIRKWOOD ORANGE	FACILITY NUMBER: 306005835
	VISIT DATE: 05/08/2024

NARRATIVE

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It was alleged that staff did not keep the facility free from pest. LPA De Perio conducted 5 resident interviews, of which 2 out of 5 resident interviews corroborated with the allegation by stating that they have observed one or two cockroaches in the facility, but stated that the facility attends to the situation by hiring pest control. 3 out of the 5 resident interviews did not corroborate with the allegation by denying of ever observing any pests at the facility. 2 out of the 2 staff interviews stated that pest control is scheduled to come to the facility monthly for maintenance. LPA De Perio conducted a tour of the facility, and of random resident rooms, and did not observe any pests. Per documentation review, facility has hired EcoLab and Optum Pest Management, and both companies have conducted work at the facility since January 2024.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted with ED Blacher.

A copy of this report was provided and explained.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC9099 (FAS) - (06/04)

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