306006084-2-1-2023-22-AS-SSAS-CMK5PK-20221228190802

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006084
Report Date: 12/19/2022
Date Signed: 02/01/2023 09:46:55 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
05/12/2022 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220512082651

FACILITY NAME:	CELESTIAL GARDEN		FACILITY NUMBER:	306006084
ADMINISTRATOR:	ALVARADO, MARY JEAN		FACILITY TYPE:	740
ADDRESS:	429 S SHIELDS DRIVE		TELEPHONE:	(714) 580-2338
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	6	CENSUS: 6	DATE:	12/19/2022
		UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Mary Jane Alvarado		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Personal Rights
(Staff sexually assaulted resident while in care.)

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Ruth Martinez conducted an unannounced visit for the purpose of delivering the findings on a complaint investigation. LPA Martinez arrived at facility was greeted and granted entry by caregiver. LPA informed staff of visit and was advised Administrator was out of the facility. Administrator arrived shortly after and met with LPA. LPA Martinez met Mary Jane Alvarado, Administrator and explained the nature of the visit.

During the investigation, the Department interviewed staff, witnesses as well as reviewed and obtained pertinent records.
The investigation revealed that resident resided at Celestial Garden facility from March 16, 2021. R1 is diagnosed with senile degeneration of brain, dementia, hypertension and additional comorbidities per

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

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-20220512082651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CELESTIAL GARDEN	FACILITY NUMBER: 306006084
	VISIT DATE: 12/19/2022

NARRATIVE

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physician’s report dated March 16, 2021. Resident is independent, and able to dress, groom herself with some assistance from the female caregivers. R1 has her own bathroom and is showered by hospice staff.

R1 was interviewed and R1 was unable to positively identify the male but believes that S1 was the male who inappropriately touched her. R1 stated that the incident occurred once while she was in her room.

S1 was interviewed and denied any sexual misconduct with R1. S1 stated that he has very little contact with R1 due the fact that R1 is independent and able to dress, groom herself with some assistance from the female caregivers. S1 stated that hospice provides showers to R1. S1 stated that he rarely contacts with R1 other than lift her from a sitting position to her walker.

The Administrator confirmed that S1’s task are housekeeping and laundry for residents and S1 assistants in transfers as needed and assist other caregivers upon request. Also, S1 prevented R1 from eloping through the patio door and raised his arm up to block R1 from exiting and may have had contact with her in the process.

R1’s responsible party was interviewed that R1 talked about being sexually abused by S1 two months ago. R1’s responsible party was informed by the Administrator that S1 stretched his arm when R1 was eloping through the patio doors and S1 may have made contact with R1. R1’s responsible party does not believe that the caregiver was sexually inappropriate with R1. R1’s responsible party did not suspect S1 had any sexual intention or inappropriate behavior to R1 and R1 may have perceived it that way.

Former Licensee, W1, was interviewed regarding R1. W1 stated resident had memory loss. R1 never complained regarding the care they provided. W1 that she and her husband and another female caregiver provided services to all the residents when she was still operating the facility. There were no other male caregivers working at the facility.

S2 was interviewed and stated that R1 is high functioning and was able to do most tasks. S2 stated that female staff attend to the female residents as this was the Administrator. S2 denies that S1 was sexually innapropriate

Continued on LIC9099-C

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20220512082651

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CELESTIAL GARDEN	FACILITY NUMBER: 306006084
	VISIT DATE: 12/19/2022

NARRATIVE

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with R1. S1 does more household chores, changing the resident’s sheets and doing their laundry and cleaning their bedrooms. S2 was present at the facility when S1 held his arm across the door to keep R1 from walking through when R1 became upset. S1 stated that it was possible that S1’s arm had contact with her chest during the time he was blocking her.

Based on the information gathered during the investigation and review of all documents obtained, the above allegation of R1 was sexually abused while in care at the facility by a male caregiver is deemed Unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted with Administrator, appeal rights explained and provided and a copy of this report was provided during the visit to the facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

LIC9099 (FAS) - (06/04)

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