<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006043
Report Date: 05/06/2024
Date Signed: 05/06/2024 04:58:43 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
02/26/2024 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240226152251
FACILITY NAME:C-P RESIDENTIAL HOMESFACILITY NUMBER:
306006043
ADMINISTRATOR:PEREZ, CELIAFACILITY TYPE:
735
ADDRESS:894 SOUTH BARNETT ST.TELEPHONE:
(714) 519-4239
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:4CENSUS: 4DATE:
05/06/2024
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Celia Perez, AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not provide supervision to client resulting in right eye injury.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the allegation listed above. LPA was greeted and granted entry by facility staff after explaining the purpose of the visit. Administrator Celia Perez was notified via telephone and arrived later to assist.

During the initial visit, LPA requested and obtained client records for all four clients at the facility. LPA accompanied by administrator toured the facility's physical plant including two of the bedrooms and one bathroom. Two staff interviews were conducted. During today's follow-up investigation visit, LPA conducted or attempted multiple client interviews. Additional witness interviews conducted via telephone during the investigation.

Regarding the allegation that Facility staff did not provide supervision to client resulting in right eye injury, the following has been concluded: CONTINUED ON FORM LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
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)
Page: 1 of 2
Control Number 22-AS-20240226152251
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: C-P RESIDENTIAL HOMES
FACILITY NUMBER: 306006043
VISIT DATE: 05/06/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
CONTINUED FROM FORM LIC9099
Based on records reviewed, staff and client interviews conducted at the facility and witness interviews, it was determined that on or around February 26, 2024, facility client C1 sustained a facial bruise that was first observed and reported at the day program that C1 regularly attends. The incident was reported to C1's Regional Center of Orange County Service Coordinator and the circumstances of the injury were investigated by facility and Regional Center staff, with C1 providing multiple accounts that could not adequately be verified. Interviews conducted during the investigation could not corroborate whether or not the injury sustained was the result of staff negligence. Furthermore, it appeared that all necessary action required by the injury was adequately taken by facility staff.

As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
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)
Page: 2 of 2