306005898-4-6-2023-22-AS-SSAS-CQRPZ3-20230410114450

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005898
Report Date: 04/06/2023
Date Signed: 04/06/2023 04:13:30 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
03/29/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230329154045

FACILITY NAME:	ELEONOR'S PLACE 3		FACILITY NUMBER:	306005898
ADMINISTRATOR:	AVENDANO, DARYLL		FACILITY TYPE:	740
ADDRESS:	26711 VALPARISO DRIVE		TELEPHONE:	(949) 547-5377
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 6	DATE:	04/06/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Mark Cruz, administrator (via phone)		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff are not following resident's dietary needs

Staff left resident in soiled diaper for an extended period of time

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit at the facility for the purpose of delivering findings into the investigation of the two allegations listed above. LPA was greeted and granted entry by caregiving staff after explaining the purpose of the visit. Facility administrator was notified of the visit by telephone and arrived later to assist.

On April 3, 2023, an initial complaint investigation visit was conducted at the facility. A tour of the facility was conducted. Records were reviewed for the six individuals currently in care. Interviews were conducted with staff and a resident. The facility log for the period following the admission of resident R1 was provided and copied by LPA as well. LPA reviewed all gathered documentation in the days following the investigation visit.

CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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-20230329154045

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ELEONOR'S PLACE 3	FACILITY NUMBER: 306005898
	VISIT DATE: 04/06/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099

Based on observation, records reviewed and interviews conducted, regarding the allegations that Staff are not following resident's dietary needs and that Staff left resident in soiled diaper for an extended period of time, the following has been concluded:

After being admitted to the facility on March 13, 2023 after his discharge from skilled nursing, the resident was identified as displaying occasional aggressive behavior towards care staff as well as refusing to comply with the special diet required by his diagnosed health needs. Despite the frequent refusal and struggle for toileting care, care staff have demonstrated continued attention for the resident and documented each instance extensively.

The resident's dietary needs have been observed to be addressed by snacking guidelines as well as through regular photographs taken of the meals by care staff. The resident's food intake was also noted to be monitored continuously by facility staff and special attention given to adapt meals to the diagnosis of Type II diabetes. Facility staff was not found to have displayed negligence or lack of care and supervision through their handling of the resident's identified needs.

Therefore, the allegations are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted and a copy of this report was provided to facility representative.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC9099 (FAS) - (06/04)

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