306005980-5-23-2024-22-AS-AJLO-D65SYY-20240611141818

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005980
Report Date: 05/23/2024
Date Signed: 05/23/2024 03:49:25 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
05/14/2024 and conducted by Evaluator Claudia Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240514131824

FACILITY NAME:	CARE VANNA		FACILITY NUMBER:	306005980
ADMINISTRATOR:	LESTER DEL ROSARIO		FACILITY TYPE:	740
ADDRESS:	2438 E PARKSIDE AVE		TELEPHONE:	(657) 224-9380
CITY:	ORANGE	STATE: CA	ZIP CODE:	92867
CAPACITY:	6	CENSUS: 5	DATE:	05/23/2024
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Karmian Calangi		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Staff verbally abuse residents.
Staff throws food at residents.

INVESTIGATION FINDINGS:

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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analysts (LPAs) Claudia Gutierrez and Michael Tea regarding the allegations mentioned above. LPA met with Staff Rio Marie Boecking and explained the purpose of the inspection.

Interviews were conducted with three facility staff, three residents, and Witness 1 (W1) regarding the allegation, staff verbally abuse residents. Per Reporting Party (RP), verbal abuse consists of shouting and bullying residents into leaving for another home. Three out of three staff interviewed denied personally shouting or bullying any resident and denied having knowledge of any other facility staff shouting or bullying residents. Two out of three residents interviewed were unable to confirm or deny if staff shout or bully them. One out of three residents interviewed denied staff shout or bully them or any other residents into leaving for another home. During their interview, W1 stated they visit the facility on a daily basis and denied witnessing staff shouting or bullying residents. (Cont. LIC9099-C)

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia Gutierrez	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

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-20240514131824

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: CARE VANNA	FACILITY NUMBER: 306005980
	VISIT DATE: 05/23/2024

NARRATIVE

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Interviews were conducted with three facility staff, three residents, and Witness 1 (W1) regarding the allegation, staff throw food at residents. Three out of three staff interviewed denied personally throwing food at any resident and denied having knowledge of any other facility staff throwing food at residents. Two out of three residents interviewed were unable to confirm or deny if staff throw food at them. One out of three residents interviewed denied staff throw food at them or any other residents. During their interview, W1 denied witnessing or having knowledge of staff throwing food at residents and stated they “have not seen any mistreatment” of a facility resident.

Due to allegations being uncorroborated during interviews conducted, LPA is unable to determine if staff are verbally abuse residents or if staff throw food at residents. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated.

An exit interview was conducted and copy of this report was provided at the end of the inspection.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia Gutierrez	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

LIC9099 (FAS) - (06/04)

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