306005902-2-27-2024-22-AS-MSTC-D2X6GE-20240229194750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005902
Report Date: 02/27/2024
Date Signed: 02/27/2024 01:52:59 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
04/25/2022 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220425124618

FACILITY NAME:	DEL OBISPO TERRACE SENIOR LIVING		FACILITY NUMBER:	306005902
ADMINISTRATOR:	NESTOR H ELIGIO		FACILITY TYPE:	740
ADDRESS:	32200 DEL OBISPO STREET		TELEPHONE:	(949) 496-8802
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY:	0	CENSUS: 0	DATE:	02/27/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:			TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Staff does not meet resident's dietary needs
Staff spoke to resident inappropriately
Facility doesn't serve food of good quality

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre completed the investigation into the allegations listed above. The facility is closed and no longer operating so the LIC 9099 is being sent to the address on record for the Licensee via mail (United States Postal Service).

The investigation into the allegation, staff does not meet resident's dietary needs revealed the following. It was reported that Resident 1 (R1) was not provided breakfast and lunch on 4/25/2022. 6 out of 6 staff interviewed denied this report. R1 reported they did not receive breakfast or lunch on 4/25/2022. Staff interviewed reported R1 called the front desk and ordered both meals. Kitchen staff reported that R1’s meals were prepared as requested. R1 verified that the front desk was called, and they ordered breakfast and lunch but never received the meals. Staff 1 (S1) reported that they delivered both breakfast and lunch to R1’s room and each time they knocked on the door and R1 did not respond. S1 reported that they left the tray by the door each time. S1 reported that after an hour they observed the tray was gone.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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-20220425124618

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: DEL OBISPO TERRACE SENIOR LIVING	FACILITY NUMBER: 306005902
	VISIT DATE: 02/27/2024

NARRATIVE

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S1 reported that they do not know if R1 took the tray in their room or someone else took it back to the kitchen. All of the staff interviewed including S1 reported that they did not remove the trays left for R1 on 4/25/2022. Based on the information gathered during the investigation, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information, therefore the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, staff spoke to resident inappropriately, revealed the following. R1 reported that on numerous occasions staff have spoken inappropriately to them but did not provide any specific details or times and dates. R1 reported that staff are mean and rude but did not provide any details. 6 out of 6 staff interviewed denied the reports. No information was gathered to support the allegation. Based on the information gathered from interviews the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur.

The investigation into the allegation, facility doesn't serve food of good quality, revealed the following. During the investigation, Licensing Program Analyst (LPA) Joseph Alejandre interviewed staff and residents and toured the kitchen of the facility. R1 reported the facility serves low quality food that is not nutritious. LPA observed during the tour of the facility kitchen that the kitchen is clean and organized. LPA observed fresh produce and bread stored in the pantry of the facility. LPA observed the refrigerators were kept at 38.0 degrees Fahrenheit and the freezers kept at 0.0 degrees Fahrenheit. LPA observed a posting in the kitchen, that the facility kitchen was inspected by the Orange County Health Care Agency (formerly Orange County Health Department) In January of 2022 and passed the inspection. LPA did not observe any food that looked of low quality or not fit for human consumption. No expired or rotten food was observed during the tour of the kitchen. LPA did not observe any Title 22 violations concerning food quality, food storage or food preparation during the 10-day visit. 6 out of 6 staff interviewed denied the allegation. No evidence to support the allegation other than R1’s report of low-quality food was observed or reported. Therefore, the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur.

The LIC 9099 is being sent to the last known address of the Licensee via mail (United States Postal Service).

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC9099 (FAS) - (06/04)

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