306005918-9-16-2022-22-AS-LADS-CJGQ68-20220921115303

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005918
Report Date: 09/16/2022
Date Signed: 09/16/2022 01:41:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/11/2022 and conducted by Evaluator Albert Marin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220111091507

FACILITY NAME:	LI'L HOUSE ON FARRINGTON, THE		FACILITY NUMBER:	306005918
ADMINISTRATOR:	JABONERO, JEREMIAS		FACILITY TYPE:	735
ADDRESS:	1241 FARRINGTON DR.		TELEPHONE:	(714) 975-3025
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	4	CENSUS: 4	DATE:	09/16/2022
		UNANNOUNCED	TIME BEGAN:	12:44 PM
MET WITH:			TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility staff are not following COVID-19 protocols.
Facility staff are not adequately supervising clients
Clients in care are being exposed to smoke.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Albert Marin made an unannouced visit to this facility to deliver the final report for the investigation completed for complaint filed last January 11, 2022. Via phone, LPA informed Administrator (AD) Janice Jabonero the purpose of this visit.

On allegation that facility staff are not following COVID-19 protocols, the following are the findings. Facility had submitted the Coronavirus 2019 (COVID)19 mitigation plan in March 2021 to Community Cre Licensing Division Orange Office for review. Facility completed immunization requirements for both staff members and client. Facility was conducting routine testing. Facility opened the garage area for shaded outdoor spaces for clients to use. Staff members wear masks while inside the facility but would sometimes take them off when outside the facility to supervise the clients. To date, facility never had a confirmed case of COVID 19 in the facility. LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

Continuation in Page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

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-20220111091507

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LI'L HOUSE ON FARRINGTON, THE	FACILITY NUMBER: 306005918
	VISIT DATE: 09/16/2022

NARRATIVE

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On allegation that facility staff are not adequately supervising clients, the following are the findings. In December 2021, during the holidays, facility conducted a holiday party last December 23, 2021; and an all staff meeting in December 28, 2021. Per interviews, all staff meeting was held during the shift change. At that time there were at least three outgoing morning staff; and 2 incoming afternoon staff. With the number of staff members present, the facility driveway was filled up. All witnesses interviewed denied inviting visitors in the facility. On observation, LPA did not observe any oil stains in the driveway nor heavy equipment in the garage to suggest that vehicle repairs were done in the facility garage and driveway. Thus, the allegation that facility staff are not adequately supervising clients is UNSUBSTANTIATED.

On allegation that clients in care are being exposed to smoke, the following are the findings. One of the clients in care is a known smoker and room is close to the main entrance. During the initial investigation visit, LPA did no observe the client to be smoking inside the facility. LPA also did not notice any cigarette scent inside the common areas of the facility. Client routinely uses the designated area for smoking. Thus the allegation that clients in care are being exposed to smoke is UNSUBSTANTIATED.

LPA Marin conducted a phone exit interview with AD Janice Jabonero. AD granted permission for staff to sign and receive the report. LPA left copy of this report in the facility.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

LIC9099 (FAS) - (06/04)

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