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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005837
Report Date: 10/18/2023
Date Signed: 10/18/2023 01:20:54 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
10/10/2023 and conducted by Evaluator Celine DePerio
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231010161029
FACILITY NAME:ORCHARDS ASSISTED LIVING, THEFACILITY NUMBER:
306005837
ADMINISTRATOR:CONK, KELLYFACILITY TYPE:
740
ADDRESS:1 AMISTAD DRIVETELEPHONE:
(949) 443-8900
CITY:RANCHO MISSION VIEJOSTATE: CAZIP CODE:
92694
CAPACITY:90CENSUS: 38DATE:
10/18/2023
UNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Facility Administrator - Brooke Patterson TIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Facility is charging fees for services not provided.
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 received on 10/10/23 and to deliver the findings. LPA De Perio explained the purpose of today's visit, 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 the facility is charging fees for services not provided. LPA conducted an interview with staff that revealed that resident 1 (R1) voluntarily wanted to extend time in the skilled nursing portion of the facility, therefore was charged, and that the current fees owed of $413.28 are from the outstanding balance that R1 had not yet paid for prior to moving out of the facility. It was also revealed that staff 1 (S1) spoke to R1 via phone call to explain about the fees, due to the services provided during the time at skilled nursing, however R1 was unable to recall what the bill was for.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
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-20231010161029
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: 10/18/2023
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.

For today's visit, no citations were issued.

An exit interview was conducted with AD Patterson. A copy of this report was provided and explained.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2