306005910-3-12-2024-22-AS-LMOA-D3TMUN-20240329095526

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005910
Report Date: 03/12/2024
Date Signed: 03/12/2024 02:59:09 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
03/11/2024 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240311115100

FACILITY NAME:	TESSA'S PLACE 3		FACILITY NUMBER:	306005910
ADMINISTRATOR:	AVENDANO, ELEONOR		FACILITY TYPE:	740
ADDRESS:	25982 VIA MAREJADA		TELEPHONE:	(949) 331-3822
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 5	DATE:	03/12/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Eleonor Avenado- Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility is in disrepair.
Facility has an infestation of termites.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced to initiate the complaint investigation into the above allegations. LPA was greeted and granted entry by Caregiver Jonnel Pelayo and stated the purpose of the visit. Administrator (Admin) Eleonor Avenado arrived on premise approximately 10:00am.

Regarding the allegation, Facility is in disrepair, LPA and Admin Avenado conducted the tour of the physical plant, interviewed two staff, and reviewed/obtained copies of pertinent documentation. The investigation revealed the following: Based on observations, there are a total of four existing video surveillance cameras in the common areas previously placed by the landlord that are inactive. The kitchen cabinet with the lazy susan was in working condition. The Heating, Ventilation, and Air Conditioning (HVAC) was maintained by the licensee on December 29, 2024. LPA tested the AC/Heating unit which was also observed to be in operable condition. Per review of the evidence, the facility did their due diligence by addressing the maintenance issues

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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 4

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
03/11/2024 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240311115100

FACILITY NAME:	TESSA'S PLACE 3		FACILITY NUMBER:	306005910
ADMINISTRATOR:	AVENDANO, ELEONOR		FACILITY TYPE:	740
ADDRESS:	25982 VIA MAREJADA		TELEPHONE:	(949) 331-3822
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 5	DATE:	03/12/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Eleonor Avenado- Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not ensure to keep the facility clean.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced to initiate the complaint investigation into the above allegation. LPA was greeted and granted entry by Caregiver Jonnel Pelayo and stated the purpose of the visit. Administrator (Admin) Eleonor Avenado arrived on premise approximately 10:00am. Regarding the allegation, Staff did not ensure to keep the facility clean, although based on observations that the kitchen counters and the basin of the sink was clean, LPA observed superficial gray marks in the basin, a small ring of rust surrounding the dishwasher air gap, and black mold on the silicone clear caulk. Other areas of the facility were clean and sanitary.

Therefore, based on LPA's observations, the preponderance of evidence standard has been met. The following allegation: Staff did not ensure to keep the facility clean is deemed SUBSTANTIATED. A deficiency is being cited as per the Title 22, Division 6, Chapter 8 of the Caliornia Code of Regulations. Please see the attached LIC9099D. An exit interview was conducted with Administrator Eleonor Avenado, and a copy of this report was provided via email at the end of the visit.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 22-AS-20240311115100

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: TESSA'S PLACE 3	FACILITY NUMBER: 306005910
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/12/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/15/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary...for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Adminstrator stated that the she will deep clean and reseal the caulk in the sink by POC due date.
	8 9 10 11 12 13 14	Based on observation, LPA and Admin observed the ring of rust surrounding the dishwasher air gap and the silicone seal around the sink turned into black mold which poses a potential Health risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20240311115100

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: TESSA'S PLACE 3	FACILITY NUMBER: 306005910
	VISIT DATE: 03/12/2024

NARRATIVE

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(such as the chipped wood floor, hole/cracks in the ceiling, and the exposed wood to the back of the property) to the landlord which had allegedly preexisted upon taking over of the facility effective January 26, 2021. Per review of the lease agreement signed on September 30, 2020, the lease agreement did not evidence clearly the chain of liability for the damage. In addition, it is documented on page 3 of the lease agreement that the tenant shall not make any repairs, alterations, or improvements without the landlord's prior written consent. The interviews also revealed that two out of the two staff attesting that the damages previously mentioned above existed prior to licensure.

Regarding the allegation, Facility has an infestation of termites, LPA and the Admin did not observe signs of termite infestation and droppings during the inspection. Facility provided evidence of the last termite intervention serviced by the pest control company on February 28, 2024.

Therefore, based on the observations made, interviews which were conducted, and the records that were reviewed, 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, therefore the following allegations: Facility is in disrepair and Facility has an infestation of termites are deemed UNSUBSTANTIATED.

An exit interview was conducted with Administrator Eleonor Avenado, and a copy of this report was provided at the end of the visit.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC9099 (FAS) - (06/04)

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