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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006195
Report Date: 12/05/2024
Date Signed: 12/05/2024 12:08:28 PM

Substantiated


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
09/18/2024 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240918160103
FACILITY NAME:WESTMINSTER TERRACEFACILITY NUMBER:
306006195
ADMINISTRATOR:CRISTINA MILLERFACILITY TYPE:
740
ADDRESS:7571 WESTMINSTER BLVDTELEPHONE:
(714) 891-6608
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:152CENSUS: DATE:
12/05/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:TIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff did not ensure residents personal property was safely secured
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 allegations listed above and delivering findings to facility staff. LPA was greeted and granted entry by front desk staff after stating the purpose of the visit. Carmen Galicia, Administrator was present and assisted with the visit.

The initial complaint investigation visit took place on September 24, 2024. During the visit, LPA requested and obtained the current facility census. Resident records including admission agreements, personal property inventories and theft and loss policy for 5 currently admitted individuals were requested and obtained. A copy of the facility's resident handbook was also provided. Follow up interviews conducted via telephone after the initial visit.

CONTINUED ON FORM LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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 5
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
09/18/2024 and conducted by Evaluator Kevin Saborit-Guasch
COMPLAINT CONTROL NUMBER: 22-AS-20240918160103

FACILITY NAME:WESTMINSTER TERRACEFACILITY NUMBER:
306006195
ADMINISTRATOR:CRISTINA MILLERFACILITY TYPE:
740
ADDRESS:7571 WESTMINSTER BLVDTELEPHONE:
(714) 891-6608
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:152CENSUS: DATE:
12/05/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:TIME COMPLETED:
12:20 PM
ALLEGATION(S):
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2
3
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5
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8
9
Staff does not ensure resident receives mail deliveries

Staff does not ensure residents laundry is returned undamaged
INVESTIGATION FINDINGS:
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5
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12
13
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 allegations listed above. LPA was greeted and granted entry by front desk staff after stating the purpose of the visit. (...) was present and assisted with the visit.

The initial complaint investigation visit took place on September 24, 2024. During the visit, LPA requested and obtained the current facility census. Resident records including admission agreements, personal property inventories and theft and loss policy for 5 currently admitted individuals were requested and obtained. A copy of the facility's resident handbook was also provided. Follow up interviews conducted via telephone after the initial 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: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20240918160103
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: WESTMINSTER TERRACE
FACILITY NUMBER: 306006195
VISIT DATE: 12/05/2024
NARRATIVE
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CONTINUED FROM LIC9099-A
Regarding the allegation that Staff does not ensure resident receives mail deliveries, the following has been concluded: Postal mail is being delivered to the facility directly in individual mailboxes located in the facility lobby, with one mailbox assigned per dwelling unit in the facility. Resident or residents living in that specific unit are then provided with a key to their assigned mailbox as confirmed by staff and resident interviews. Staff does not possess keys and does not have access to resident's mailboxes. No specific and/or documented instances of mail being tampered with were provided during the investigation.

Regarding the allegation that Staff does not ensure residents laundry is returned undamaged, the following has been concluded: The evidence gathered during the investigation through staff and resident interviews along with records review did not provide sufficient evidence to identify any instances of facility staff being responsible for damaging or destroying a resident's laundry through established negligence.

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 evidence to prove or refute the alleged violations occurred.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20240918160103
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: WESTMINSTER TERRACE
FACILITY NUMBER: 306006195
VISIT DATE: 12/05/2024
NARRATIVE
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Staff did not ensure residents personal property was safely secured, the following has been concluded: Based on staff and resident interviews conducted, reports of missing or alleged stolen items are gathered by facility staff and generally result in corrective measures being taken such as involving staff to search for the missing items or funds, or reevaluating unit assignments if the issue appears to be triggered by residents sharing the same living unit. However, according to an interview with facility administrator conducted during the initial complaint investigation, facility staff does not maintain the required documentation of missing property including a description of the article, its estimated value, the date and time the theft or loss was discovered, if determinable, the date and time the loss or theft occurred as well as the action taken as described in section 1569.153(c) of the Health and Safety Code. As a result, facility staff was unable to provide detailed information on potential theft or loss incidents being investigated when requested by the Department.

As a result, the allegation is found to be Substantiated, meaning that the preponderance of evidence standard has been met. A type B deficiency is cited on the attached form LIC9099-D. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20240918160103
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: WESTMINSTER TERRACE
FACILITY NUMBER: 306006195
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2025
Section Cited
HSC
1569.153(c)
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"A theft and loss program shall be implemented [which] shall include (...):(c) Documentation of lost and stolen resident property with a value of twenty-five dollars ($25) or more (...) and, upon request, the documented theft and loss record for the past 12 months shall be made available (...)
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Facility staff to establish a log and provide LPA with evidence of its use before the plan of corrections due date.
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(...) to the State Department of Social Services(...) in response to a specific complaint." This requirement was not met as evidenced by the absence of a facility log being maintained, which constitutes a potential risk to the healh, safety and personal rights of residents 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: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5