306006047-11-17-2022-22-AS-LADS-CMSW3F-20230105155549

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006047
Report Date: 11/17/2022
Date Signed: 11/17/2022 10:58:07 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
09/07/2022 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220907085204

FACILITY NAME:	KNOTT'S LANDING LUXURY CARE		FACILITY NUMBER:	306006047
ADMINISTRATOR:	RAJPOOT, FAISAL		FACILITY TYPE:	740
ADDRESS:	6359 ARNOLD WAY		TELEPHONE:	(949) 290-1826
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	6	CENSUS: 5	DATE:	11/17/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Faisal Rajpoot		TIME COMPLETED:	11:05 AM

ALLEGATION(S):

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Facility failed to award privacy to resident during phone calls.
Facility failed to safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to deliver the findings on the complaint allegations above. LPA identified himself and discussed the purpose of the visit with staff.

The investigation into the allegation “Facility failed to award privacy to resident during phone calls.” “Facility failed to safeguard residents personal belongings.” revealed the following:

During the initial visit September 8, 2022, LPA Haley interviewed Administrator (AD) Faisal Rajpoot, facility staff, and residents. LPA received information from multiple residents and multiple staff that contradicts both allegations above. During the interview process LPA Haley learned that residents have the option to use their own cell phone, the facility phone, and resident have access to caregiver cell phones. After interviews during the initial visit and multiple phone calls with the Reporting Party (RP), LPA Haley did not receive any information that supports the allegation “Facility failed to safeguard resident’s personal belongings.”

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

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-20220907085204

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: KNOTT'S LANDING LUXURY CARE	FACILITY NUMBER: 306006047
	VISIT DATE: 11/17/2022

NARRATIVE

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Based on the information gathered during the investigation, document review and interviews, the Department is unable to ascertain if the 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 provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC9099 (FAS) - (06/04)

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