306005837-9-14-2023-22-AS-MVAO-CW5UK5-20230929153834

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005837
Report Date: 09/14/2023
Date Signed: 09/14/2023 03:55:04 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
09/08/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230908144438

FACILITY NAME:	ORCHARDS ASSISTED LIVING, THE		FACILITY NUMBER:	306005837
ADMINISTRATOR:	CONK, KELLY		FACILITY TYPE:	740
ADDRESS:	1 AMISTAD DRIVE		TELEPHONE:	(949) 443-8900
CITY:	RANCHO MISSION VIEJO	STATE: CA	ZIP CODE:	92694
CAPACITY:	90	CENSUS: 62	DATE:	09/14/2023
		UNANNOUNCED	TIME BEGAN:	01:58 PM
MET WITH:	Facility Administrator - Brooke Patterson		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Licensee did not abide by the terms of the admission agreement.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced 10-day visit to the facility and to deliver the findings. LPA De Perio explained the purpose of today's visit, and was greeted by facility administrator (AD) Brooke Patterson.

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 licensee did not abide by the terms of the admission agreement. An interview conducted with the resident (R1) who stated that the facility had mailed R1 copies of documents and invoices per R1 request, but "forgot" about it. R1 also verified with LPA De Perio that a copy of the admission agreement was given to R1, however, R1 misplaced it, but confirmed that the facility did provide it to R1.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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-20230908144438

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: ORCHARDS ASSISTED LIVING, THE	FACILITY NUMBER: 306005837
	VISIT DATE: 09/14/2023

NARRATIVE

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Based on LPA’s interviews which were conducted, review of documents obtained, and observations, this allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with AD Patterson.

A copy of this report was provided and explained.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC9099 (FAS) - (06/04)

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