306005939-5-6-2024-22-AS-MVAO-D5JV38-20240523160418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005939
Report Date: 05/06/2024
Date Signed: 05/06/2024 10:30:34 AM

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
03/22/2024 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240322145707

FACILITY NAME:	ADULT CARE OC I		FACILITY NUMBER:	306005939
ADMINISTRATOR:	SCHOTT, BRIAN		FACILITY TYPE:	740
ADDRESS:	25032 WOOLWICH ST		TELEPHONE:	(626) 864-9955
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	6	CENSUS: 5	DATE:	05/06/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Fairlane Delos Reyes		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff did not allow resident to select their own hospice agency

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with Administrator (AD) Fairlane Delos Reyes, discussed the purpose of the inspection, and explained the allegation.

The investigation into the allegation that staff did not allow resident to select their own hospice agency revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, residents, staff, and witnesses, and obtained and reviewed copies of the resident roster, staff roster, and resident files.

CONTINUED

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

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-20240322145707

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: ADULT CARE OC I	FACILITY NUMBER: 306005939
	VISIT DATE: 05/06/2024

NARRATIVE

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Regarding the allegation that staff did not allow resident to select their own hospice agency: it was alleged that the facility forces residents to use Equinox hospice agency by charging a higher rate for residents who use other agencies. LPA interviewed two staff, but did not obtain information corroborating the allegation. LPA reviewed resident files and noted that two residents are currently on hospice and both use Equinox hospice agency. LPA interviewed the two residents on hospice, one of whom was unable to communicate, and did not obtain information corroborating the allegation. LPA interviewed AD, the licensee, and a witness associated with the facility who denied the allegation and stated that while both residents on hospice at this facility are currently using Equinox hospice agency this has not always been the case and the licensee’s other facilities house residents using other hospice agencies, that the facility recommends Equinox hospice agency to residents due to the better and more responsive care residents receive from this agency as opposed to other agencies, and that while the facility prefers Equinox hospice agency because it is more responsive to staff calls and resident needs the facility does not pressure residents to choose this agency other than by simply recommending use of this agency. LPA interviewed one witness and attempted to interview two additional witnesses and obtained conflicting information. The information obtained is conflicting.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegation occurred as reported. 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 discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

LIC9099 (FAS) - (06/04)

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