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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006073
Report Date: 10/12/2023
Date Signed: 10/12/2023 11:23:56 AM

Substantiated


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
08/23/2023 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230823100033
FACILITY NAME:EDEN BY ENHANCEFACILITY NUMBER:
306006073
ADMINISTRATOR:KHOUIE, CHRISTINAFACILITY TYPE:
772
ADDRESS:35 MANN STREETTELEPHONE:
(949) 617-5642
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY:6CENSUS: 6DATE:
10/12/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Melody Fathi - Program Director TIME COMPLETED:
11:35 AM
ALLEGATION(S):
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Facility did not complete the clients Admission Agreements
Facility did not complete the clients Needs and Services Plan
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made unannounced follow up visit regarding the complaint allegations above. The initial unannounced complaint visit was completed August 30, 2023. Interviews were conducted and documents were provided including the Plan of Operation.

Regarding the allegation: Facility did not complete the clients Admission Agreement

During the investigation, interview confirmation and record review revealed the Admission Agreement for Client 1 (C1) and Client 2 (C2) were not completed as specified in the facilities plan of operation page #14) (B) Admission Procedure 1: Upon admit, clients are to complete and sign all necessary documents including, but not limited to: b. Admission Agreement
C1 was admitted July 28, 2023 and the admission agreement was signed July 29, 2023. C2 was admitted July 24, 2023 and the admission agreement was signed July 25, 2023.
Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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 3
Control Number 22-AS-20230823100033
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: EDEN BY ENHANCE
FACILITY NUMBER: 306006073
VISIT DATE: 10/12/2023
NARRATIVE
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Regarding the allegation: Facility did not complete the clients Needs and Service Plan

Interview confirmation and document review revealed C2 and Client 3 (C3) did not have a completed assessment of meal planning, shopping, and budgeting which is found in the Needs and Service Plan. The Needs and Service Plan was not completed as specified in the facilities Plan of Operation page #15) 5. A written assessment of each client at time of admission will be completed within 24-hours, which includes a minimum: k. Eden By Enhance staff shall ensure that a written Needs and Service Plan is started prior to admission, and completed prior to or within 72 hours of admission.

Based on the evidence gathered through document review, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22, Division 6.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20230823100033
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: EDEN BY ENHANCE
FACILITY NUMBER: 306006073
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/19/2023
Section Cited
CCR
81022(j)
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81022 Plan of Operation

(j) The facility shall operate in accordance with the terms specified in the plan of operation and may be cited for not doing so. This requirement is not being met as evidenced by
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Program Director Melody Fathi agrees to review regulation section 81022 Plan of Operation and provided a written statement on steps taken to prevent this from happening in the future. The signed statement will be provided on or before the POC due date, October 19, 2023, 1PM.
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Interview confirmation and document review which revealed two clients did not sign their admission agreement upon admission as specified in the plan of operation. This poses a potential health and safety risk to clients in care.
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Type B
10/19/2023
Section Cited
CCR
81068.2(b)(1)
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81068.2 Needs and Service Plan
(b) For each client admitted...a written Needs and Services Plan is started prior to admission, and completed... within 72 hours of admission, that must include:
(1) A written assessment as required in California Code of Regulations, Title 9, Division 1, Chapter 3, Article 3.5, Section 532.2(b).
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Program Director Melody Fathi agrees to review regulation section 81068.2 Needs and Service Plan and provided a written statement on steps taken to avoid this from happening in the future. The signed statement will be provided on or before the POC due date, October 19, 2023, 1PM.
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This requirement is not being met as evidenced by interview confirmation and document review which confirmed two clients did not have a completed assessment of meal planning, shopping, and budgeting. This poses a potential health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3