306005836-6-20-2023-22-AS-AORZ-CT7MCZ-20230627093023

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005836
Report Date: 06/20/2023
Date Signed: 06/20/2023 03:33:01 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
06/16/2023 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20230616165213

FACILITY NAME:	CASA DOLCE HOME		FACILITY NUMBER:	306005836
ADMINISTRATOR:	EMIGH, JEANINE		FACILITY TYPE:	740
ADDRESS:	1601 SKYLINE DRIVE		TELEPHONE:	(714) 213-8423
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92831
CAPACITY:	6	CENSUS: 4	DATE:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Jeanine Emigh		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee did not provide proper notice to residents of change of ownership
Facility staff changed residents without their consent
Facility staff closed fire doors

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility by Licensee/ Administrator Jeanine Emigh and explained the reason for the visit. Prospective Licensee Megan Cheng was present as well.
During the course of the investigation, LPA toured the facility, interviewed staff, residents and witness as well as reviewed and obtained pertinent documentation such as Administrator Certificate and facility notification to resident families. Regarding the allegations that licensee did not provide proper notice to residents of change of ownership, facility staff changed residents without their consent, and facility staff closed fire doors, the investigation revealed the following: On 06/12/2023, Licensee provided notice to staff and resident families of upcoming change of ownership. Facility is at the beginning stages of transition with prospective Licensee preparing to apply for a license. Current Licensee is preparing to finalize the purchase deal. Prospective Licensee/ Administrator states being on-site consulting with Licensee but not actively working. Staff 1 (S1) was on-site during a NOC shift on 06/14/2023. CONT ON LIC 9099 DATED 06/20/2023.

Unfounded

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: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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 2

Control Number 22-AS-20230616165213

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 DOLCE HOME	FACILITY NUMBER: 306005836
	VISIT DATE: 06/20/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Residents interviewed deny S1 providing any caregiving but state being startled by the presence of a male caregiver. Prior to 06/14/2023, facility has been all female including caregivers. S1 has a current Administrator Certificate expiring on 01/24/2023. Witness denies closing fire door however proper fire protocol indicates fire doors should be maintained closed. During today's visit, fire door is open and affixed properly to the wall. Therefore the allegations are deemed UNFOUNDED, meaning the allegations were false, could not have happened and/or is without a reasonable basis.
Exit interview conducted and a copy of this report was provided to facility representative.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2