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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005946
Report Date: 01/23/2025
Date Signed: 01/23/2025 05:17:10 PM

Substantiated


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
01/13/2025 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250113121428
FACILITY NAME:SERRA SOLFACILITY NUMBER:
306005946
ADMINISTRATOR:LINDSAY SCHROEDERFACILITY TYPE:
740
ADDRESS:31451 AVENIDA LOS CERRITOSTELEPHONE:
(949) 485-2022
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:70CENSUS: 50DATE:
01/23/2025
UNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Lindsay SchroederTIME COMPLETED:
05:25 PM
ALLEGATION(S):
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Facility did not provide requested documents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Executive Director Lindsay Schroeder and explained the reason for the visit. The investigation revealed the following. LPA interviewed the Executive Director and witness 1. Witness 1 reported that the responsible party requested the facility records for Resident 1 (R1) on December 19, 2024 and the facility acknowledged the request but no records were provided. It was reported that on January 3, 2025 the facility was contacted again about the records request but the facility did not respond and as of January 22, 2025 no records have been received. The Executive Director verified this information and reported the document request was received and the document will be provided by January 28, 2025. Based on the evidence gathered through interviews the preponderance of evidence standard has been met therefore the allegation is substantiated. Deficiency is being cited per Title 22, division 6 of the California Code of Regulations. An exit interview was conducted, a copy of the this report (LIC809) along with the citation (LIC809D) and appeal rights was provided to the Executive Director.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
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-20250113121428
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: SERRA SOL
FACILITY NUMBER: 306005946
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2025
Section Cited
HSC
1569.269(a)(21)
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To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days, at a cost not to exceed the community standard for photocopies. This requirement was not met as evidenced by,
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Licensee agrees to provide the records requested by January 28, 2025 and the Executive Director will sign a statement of understanding for the regulation HSC 1569.269, proof of completion to be submitted to the LPA by January 31, 2025.
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Based on interviews the facility did not provide the requested documents within two business days, once requested. This poses a personal rights risk to residents.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2