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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005908
Report Date: 07/30/2024
Date Signed: 07/30/2024 04:15:58 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
07/24/2024 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240724082752
FACILITY NAME:WESTMONT OF CYPRESSFACILITY NUMBER:
306005908
ADMINISTRATOR:PATRICK FRAZIERFACILITY TYPE:
740
ADDRESS:4889 & 4775 KATELLA AVE.TELEPHONE:
(858) 729-6720
CITY:LOS ALAMITOSSTATE: CAZIP CODE:
90720
CAPACITY:152CENSUS: 130DATE:
07/30/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nancy RodriguezTIME COMPLETED:
01:29 PM
ALLEGATION(S):
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Staff are not delivering meals to the resident timely
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit regarding the complaint allegation above. LPA Haley was greeted, granted entry, and explained the reason for the visit. During the visit LPA Haley toured the facility, interviewed staff, residents, and collected and reviewed relevant documents.

Regarding the allegation: Staff are not delivering meals to the resident timely.

11 of 12 individuals interviewed including facility residents and staff were unable to corroborate the allegation above. During an interview with multiple staff members, it was discovered staff took orders for breakfast and lunch a day early so meals could be prepared and served at a reasonable time. Multiple staff members did acknowledge there were some residents who complained they did not receive their food, but after checking a master list of orders and meals delivered to residents, the resident received a meal every time.

Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
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-20240724082752
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: WESTMONT OF CYPRESS
FACILITY NUMBER: 306005908
VISIT DATE: 07/30/2024
NARRATIVE
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Staff 3 (S3) explained there are some confused residents in the building and even before residents were isolated during the outbreak, some residents would come down to the kitchen and claim they never ate due to their confusion. All the residents interviewed during the investigation denied the allegation and did not have a problem with the food service during the isolation period.

Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegation: Staff are not delivering meals to the resident timely. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2