306005924-7-5-2023-22-AS-SSAS-CTQPHV-20230714112035

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005924
Report Date: 07/05/2023
Date Signed: 07/05/2023 02:29:55 PM

Unfounded

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
06/20/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230620130603

FACILITY NAME:	NEW HOME SENIOR CARE 4		FACILITY NUMBER:	306005924
ADMINISTRATOR:	SCHOTT, BRIAN		FACILITY TYPE:	740
ADDRESS:	24516 SATURNA DRIVE		TELEPHONE:	(626) 864-9955
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 5	DATE:	07/05/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Fairlane Delosreyes, Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Personal Rights Violation

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the allegation listed above.

On June 21, 2023, LPA conducted an initial complaint investigation at the facility. LPA requested and obtained resident records for all five individual in care at the time of the visit. LPA accompanied by administrator toured the physical plant. No violations implicating the Health and Safety of the individuals in care observed during the visit.

After review of the resident records, it was confirmed that the alleged victim included in the complaint did not either currently or previously reside at this licensed location. The allegation is therefore deemed to be unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided to a facility representative.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

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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