306006189-6-20-2024-22-AS-SSAS-D7HUYY-20240725160039

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006189
Report Date: 06/20/2024
Date Signed: 06/20/2024 08:55:59 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
06/12/2024 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240612135214

FACILITY NAME:	KAEGO'S RICHMAN GARDENS		FACILITY NUMBER:	306006189
ADMINISTRATOR:	HARVEY, LUPE		FACILITY TYPE:	740
ADDRESS:	317 N. RICHMAN GARDENS		TELEPHONE:	(714) 733-7518
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92831
CAPACITY:	26	CENSUS: 24	DATE:	06/20/2024
		UNANNOUNCED	TIME BEGAN:	07:30 AM
MET WITH:	Rosalba Maldonado		TIME COMPLETED:	09:10 AM

ALLEGATION(S):

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Facility staff are not providing records to resident's responsible person(s)

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Staff #1 (S1) Rosalba Maldonado, discussed the purpose of the inspection, and explained the allegation. Administrator (AD) Lupe Harvey was not present during the inspection.

The investigation into the allegation that facility staff are not providing records to resident's responsible person(s) revealed the following: During the course of the investigation, LPA inspected the facility, interviewed facility staff, and obtained and reviewed copies of the resident roster, staff roster, a witness statement dated June 11, 2024, and a written request for Resident #1’s (R1) Resident File dated December 28, 2023.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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-20240612135214

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: KAEGO'S RICHMAN GARDENS	FACILITY NUMBER: 306006189
	VISIT DATE: 06/20/2024

NARRATIVE

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Regarding the allegation that facility staff are not providing records to resident's responsible person(s): it was alleged that on December 28, 2023, R1’s Resident File was requested, the facility did not provide R1’s Resident File, facility staff were contacted by phone on January 31, 2024 and confirmed the request was mailed to the correct address, the request was sent again via certified mail, but as of June 12, 2024, the facility still had not provided R1’s Resident File. LPA reviewed a witness statement dated June 11, 2024, and a written request for R1’s Resident File dated December 28, 2023, which corroborated the allegation. LPA interviewed facility staff who corroborated that the facility had received the request on or before January 9, 2024, and had not provided R1’s Resident File by that date which is more than two business days from the request, but could not provide information on whether R1’s Resident File was ever provided. Based on the information obtained, the facility did not timely provide R1’s Resident File in response to the request.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20240612135214

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: KAEGO'S RICHMAN GARDENS	FACILITY NUMBER: 306006189
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/20/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/27/2024 Section Cited CCR 87468.2(a)(19)	1 2 3 4 5 6 7	87468.2 Additional Personal Rights… (a) … (19) To have prompt access to review all of their records ... within two (2) business days... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated they will properly respond to the request for R1’s Resident File and submit proof to LPA by POC due date.
	8 9 10 11 12 13 14	Based on interviews and documents, the licensee did not ensure R1 had access to their records within two business days of the request dated December 28, 2023, which poses a potential personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean Haddad	TELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

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