306006067-10-30-2024-22-AS-SSAS-DAK6MN-20241030205613

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006067
Report Date: 10/30/2024
Date Signed: 10/30/2024 12:07:06 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
09/25/2024 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240925163513

FACILITY NAME:	FAITH HOME CARE, LLC		FACILITY NUMBER:	306006067
ADMINISTRATOR:	TECSON, ALEXANDER		FACILITY TYPE:	735
ADDRESS:	2367 W HANSEN ST.		TELEPHONE:	(714) 496-1732
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	4	CENSUS: 4	DATE:	10/30/2024
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Purita Ramos, Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Licensee did not ensure that facility is a safe and healthy environment for clients in care

Facility did not ensure that clients were accorded with dignity in his/her personal relationships with staff and other persons.

INVESTIGATION FINDINGS:

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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 two allegations listed above, as well as delivering findings to the licensee. LPA was greeted and granted entry by facility staff after stating the purpose of the visit. Administrator Purita Ramos was present during the visit as well.

An initial complaint investigation visit took place on October 1, 2024. LPA requested and obtained client records for the three clients involved in an incident dated 09/21/2024 reported to the Regional Center of Orange County, including admission agreements, physician reports and individual program plans and their respective revisions. Two staff interviews were conducted during the visit.

Additional interviews with Regional Center of Orange County staff and other witnesses were conducted via telephone after the initial investigation visit.
CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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-20240925163513

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: FAITH HOME CARE, LLC	FACILITY NUMBER: 306006067
	VISIT DATE: 10/30/2024

NARRATIVE

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CONTINUED FROM FORM LIC9099
During the present visit, LPA conducted or attempted to conduct interviews with facility client and administrator. Staff notes were also reviewed and added to the investigation file.

Client C1 was the most recent admitted client into the facility at the time of his move into the facility on May 23, 2024. According to staff members interviewed, the other clients had an already established group dynamic and C1's arrival required adjustments from all involved. A 30-day review from facility staff dated June 15, 2024 does not indicate any interpersonal issues with the other clients at that time and states: "[C1] became friends with our other residents [...] within the first day of meeting them". Additionally, based on the quarterly review meeting involving C1, their family and C1's Regional Center of Orange County's Service Coordinator dated July 15, 2024: "Current placement is reported and appears stable and appropriate. [C1]'s needs are being met at current placement and continued staff support".

Based on an incident report submitted by Regional Center of Orange County on September 25, 2024, on September 21, 2024, facility staff reported that client C3 verbally insulted C1 after becoming agitated and frustrated online. Client C2 joined into the verbal antagonizing upon their arrival from work later the same day. Client C3 has a documented history of disruptive social behavior per their records maintained at the facility. Following the incident, administrator increased staffing to ensure such direct confrontations could be avoided. Additionally, meetings with C2 and C3's Service Coordinators and family members were initiated on September 30, 2024 and October 16, 2024. Regional Center of Orange County staff with knowledge of the facility and clients both stated that in their opinion the facility's response had been adequate.

Regarding the allegations that Licensee did not ensure that facility is a safe and healthy environment for clients in care and that Facility did not ensure that clients were accorded with dignity in his/her personal relationships with staff and other persons, the investigation found that facility staff appeared to have acted appropriately and timely to ensure that the clients potential disruptive behaviors did not compromise other admitted individuals' personal rights.

As a result, both allegations are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report was provided to facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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