306005991-2-26-2024-22-AS-MSTC-D2X68A-20240229193450

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005991
Report Date: 02/26/2024
Date Signed: 02/26/2024 02:09:04 PM

Unsubstantiated

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
08/04/2022 and conducted by Evaluator Ruth Martinez

COMPLAINT CONTROL NUMBER: 22-AS-20220804082401

FACILITY NAME:	GARDEN GROVE GUEST HOME LLC		FACILITY NUMBER:	306005991
ADMINISTRATOR:	YVETTE LEM		FACILITY TYPE:	740
ADDRESS:	12882 SHACKELFORD LANE		TELEPHONE:	(714) 638-9470
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY:	47	CENSUS: 41	DATE:	02/26/2024
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Ruben Ramirez		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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insufficient staffing to meet resident's needs

Staff are not answering residents call lights timely

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegations. LPA met with Ruben Ramirez, Administrator and explained the nature of the visit.

Based on the information obtained during this investigation the department has concluded the investigation into the above mentioned allegations. Findings are based upon this investigation which included interviews conducted, tour of phydical plant and copies of pertinent documents obtained. It is alleged that the facility has insufficient staffing to meet residents’ needs. Records review revealed that at the time of visit facility census was 32 and facility staff schedule showed the facility to have 12 caregivers on the schedule. The monthly caregiver staffing schedule reflected that there were five shifts per day and there was two to three caregivers scheduled per shift. Interview with Administrator indicated that all shifts had caregivers and

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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-20220804082401

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: GARDEN GROVE GUEST HOME LLC	FACILITY NUMBER: 306005991
	VISIT DATE: 02/26/2024

NARRATIVE

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MedTech scheduled per shift. Title 22 regulation 87411(a) Personnel Requirements-General states: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment, and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. Interviews conducted with 5 of 5 residents indicated that they felt that staff assisted them when requested, didn’t have to wait too long for help and never had an issue with not getting the help they needed. It is alleged staff are not answering residents call lights timely. Interviews with 5 of 5 residents indicated that they didn’t feel like they had to wait too long when the call light was pressed. Residents indicated that when they needed or required a caregiver’s assistance that they would get it all the time. Residents furthermore indicated that they never had an occasion where they didn’t get help that was needed. Residents indicated that if they have to wait, they do but not for too long, they also indicated that they have never pressed the call light and not gotten help. Facility observation call light when pressed rings to the front facility staff and staff notifies the caregiver. When call light is pressed it was observed that the alert could be heard loudly over the loud speaker at the facility. LPA observed that alert could be heard with a door closed which could allow caregivers to hear the alert in the vent the front office staff was busy or away from the front.

Based on the information gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations 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.

This report was reviewed with Administrator and a copy was furnished to the facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC9099 (FAS) - (06/04)

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