306005891-5-14-2025-22-AS-AORZ-DH6RWW-20250530132349

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005891
Report Date: 05/14/2025
Date Signed: 05/14/2025 03:54:27 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
10/10/2023 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231010081704

FACILITY NAME:	NANTUCKET HOME		FACILITY NUMBER:	306005891
ADMINISTRATOR:	CANDIAS, JACOB		FACILITY TYPE:	737
ADDRESS:	1051 NANTUCKET ST.		TELEPHONE:	(562) 267-0102
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	3	CENSUS: 2	DATE:	05/14/2025
		UNANNOUNCED	TIME BEGAN:	12:33 PM
MET WITH:	Andrea Starling- Register Behavior Technician, Mafa Seti-Administrator Assistant		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff training records are not being maintained
Client records are not being maintained
Facility does not have emergency supplies

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on October 10, 2023. LPA was greeted and granted entry into the facility and met with Register Behavior Technician (RBT) Andrea Starling. LPA explained the reason for the visit. Administrator (AD) Mafa Seti arrived shortly after.

This Department has investigated the complaint alleging staff training records are not being maintained. Regarding the allegation the following was revealed: During the course of the investigation LPA reviewed the hands-on training on Restricted Health Condition Care Plan (RHCP) for Asthma dated October 05, 2023. Per in-service the training topics included information and instructions for use of Albuterol and information regarding Asthma. LPA reviewed the hands-on training on RHCP for Asthma dated April 04, 2025. Per in-service the training topics included Asthma, medication order/instructions, and information and instructions for use of Ventolin inhaler.
CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

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-20231010081704

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: NANTUCKET HOME	FACILITY NUMBER: 306005891
	VISIT DATE: 05/14/2025

NARRATIVE

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Regarding the allegation that Client records are not being maintained, the following was revealed: During the course of the interviews with individuals one of five individuals interview confirmed the allegations. During the course of the interviews with staff, Staff 1 (S1) reported that the client records are up to date because the AD updates the files every time they are at the facility. Per S2 the client records are up to date. During the initial visit on October 19, 2023, and subsequent visit on May 14, 2025, LPA observed that the dietician assessments for two of two clients in care were available. During the initial visit on October 19, 2023, and subsequent visit on May 14, 2025, LPA reviewed and observed that the psychiatrist and podiatrist notes were available for clients in care. During the initial visit LPA observed that a RHCP on Albuterol for Client 1 (C1) was available for review.

Regarding the allegation that facility does not have emergency supplies, the following was revealed: During the course of the interviews with staff, S1 reported that the facility keeps emergency food and water in the garage. S2 stated that the clients have a personal emergency supplies backpack that staff have assembled for them. During the initial and subsequent visit LPA tour the facility and observed that the clients have an emergency bag which contains shoes, clothes, snacks, client's face sheet, a copy of Identification, and medication list. LPA observed that a First Aid kit and flashlights are available for use.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, these allegation are deemed UNSUBSTANTIATED.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.

LPA conducted an exit interview with AD Seti, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2025

LIC9099 (FAS) - (06/04)

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