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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005844
Report Date: 01/24/2025
Date Signed: 01/24/2025 05:40:58 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
11/04/2024 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20241104140531
FACILITY NAME:BLUE SKIES OF LAGUNA NIGUELFACILITY NUMBER:
306005844
ADMINISTRATOR:RUTH KHAYFACILITY TYPE:
740
ADDRESS:25437 VIA ESTUDIOTELEPHONE:
(949) 503-3553
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 5DATE:
01/24/2025
UNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Chet KhayTIME COMPLETED:
05:50 PM
ALLEGATION(S):
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Staff are not able to communicate with residents in an effective manner due to language barrier.
Licensee is not ensuring that facility is kept in a sanitary condition.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegations listed above. LPA met with Administrator Chet Khay and explained the reason for the visit. The investigation into the allegation, staff are not able to communicate with residents in an effective manner due to language barrier, revealed the following. LPA interviewed the Administrator and 4 staff members who reported no issues communicating with staff. LPA interviewed 4 out of 5 residents, who reported that they had no issues communicating with any of the staff. One resident was asleep and not interviewed. Two former staff members contact information is no longer valid and could not be reached for interview. The Administrator reported that all staff members and the 2 former staff members are bilingual and had no issues communicating with anyone. None of the evidence gathered supports the allegation, therefore the allegation is deemed unsubstantiated, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
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-20241104140531
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: BLUE SKIES OF LAGUNA NIGUEL
FACILITY NUMBER: 306005844
VISIT DATE: 01/24/2025
NARRATIVE
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The investigation into the allegation, Licensee is not ensuring that facility is kept in a sanitary condition, revealed the following. It was alleged that the facility dog who lives at the facility tracked feces into the entry way of the facility and there was a urine soaked pad on the floor in the living room/main entry of the facility. LPA interviewed 4 out of 5 residents who could not recall any such incident. LPA interviewed 4 staff members and the Administrator who reported such an incident never happened. The Administrator and staff reported that the facility dog goes to the bathroom outside and has not tracked anything inside. No evidence was provided to support the allegation, therefore the allegation is deemed unsubstantiated, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2