306006062-5-16-2023-22-AS-AORZ-CTTQNJ-20230717121913

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006062
Report Date: 05/16/2023
Date Signed: 05/16/2023 04:57:01 PM

Unfounded

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
05/09/2023 and conducted by Evaluator Rosie Quiroz

COMPLAINT CONTROL NUMBER: 22-AS-20230509084157

FACILITY NAME:	JADE GUEST HOME		FACILITY NUMBER:	306006062
ADMINISTRATOR:	DAO, BREVET		FACILITY TYPE:	740
ADDRESS:	2710 N. BERKELEY ST		TELEPHONE:	(714) 507-8040
CITY:	ORANGE	STATE: CA	ZIP CODE:	92865
CAPACITY:	6	CENSUS: 6	DATE:	05/16/2023
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Brevet Dao, Administrator (Via telephone) ,Teresa Delpilar (Caregiver)		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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-Facility staff did not ensure that wheelchair bound resident has safe access to the restroom.

INVESTIGATION FINDINGS:

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On today's day Licensing Program Analyst (LPA) Rosie Quiroz made an unannounced complaint visit to address the allegation listed above. LPA Quiroz was greeted and granted entry into the facility by Caregiver Teresa Del Pilar and explained the reason for the visit. Caregiver DePilar called Administrator (AD) Brevet Dao. LPA Quiroz discussed purpose of today's visit with AD Dao via telephone.
Regarding the allegation: "Facility staff did not ensure that wheelchair bound resident has safe access to the restroom," the investigation revealed the following:

During today's visit, LPA Quiroz observed and inspected two of two bathrooms in the facility. During today's visit, Caregiver Teresa Del Pilar demonstrated how a large size wheel chair is able to fit in and out of bathroom near facility entrance. Interviews conducted with five of five interviewees revealed that they are aware that front bathroom near facility entrance accomodates easily wheelchair access availability.

CONTINUED ON NEXT PAGE...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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-20230509084157

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: JADE GUEST HOME	FACILITY NUMBER: 306006062
	VISIT DATE: 05/16/2023

NARRATIVE

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Three of three residents interviewed requiring wheel chair access indicated staff assists them to bathroom near facility entrance without any wheelchair problems.

Interviews conducted with 4 of 5 interviewees indicated that they are aware they can also enter through the private bathroom to access the second bathroom utilizing a wheelchair indicating "But we don't do that because there are residents in there." (AD) Dao indicated that she would be relocating residents to accommodate those requiring wheelchair to ambulate to be in private bedroom with direct wheel chair bathroom access and that for future admissions the facility will be using the private bedroom for those residents who require wheelchairs.

During interview with Resident 1 (R1), (R1) indicated "I knew that I could use the front bathroom, but I didn't. I just wanted to leave from there that's why I said that."

Therefore based on the preponderance of evidence through interviews conducted and observations conducted by LPA Quiroz, the allegation that the "Facility staff did not ensure that wheelchair bound resident has safe access to the restroom" is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint.

No deficiencies cited during today's visit.

An exit interview was conducted with Caregiver Depilar per (AD) Dao's request and a copy of this report was provided to Caregiver Teresa Delpilar at exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

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