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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006269
Report Date: 01/30/2025
Date Signed: 01/30/2025 12:30:52 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
10/30/2024 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20241030143052
FACILITY NAME:GRANNY'S PLACE #7FACILITY NUMBER:
306006269
ADMINISTRATOR:NESBITT, MICHELLEFACILITY TYPE:
740
ADDRESS:24332 SPARTAN STTELEPHONE:
(949) 533-5938
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
01/30/2025
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Jozef Springer, Executive AdministratorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff got in a verbal altercation in front of residents
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 allegation listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator staff were notified by telephone and arrived later to assist with the visit.

An initial complaint investigation visit was conducted on November 4, 2024. LPA accompanied by facility staff conducted a tour of the physical plant. LPA requested and obtained resident records which were reviewed during the visit. A joint interview was conducted with administrative staff during the visit.

During the present visit, LPA conducted or attempted six resident interviews along with two staff interviews.

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

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
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 2
Control Number 22-AS-20241030143052
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: GRANNY'S PLACE #7
FACILITY NUMBER: 306006269
VISIT DATE: 01/30/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Staff got in a verbal altercation in front of residents, the following has been concluded: Based on records reviewed and interviews conducted, it has been confirmed that a verbal argument has taken place between two staff members on October 24, 2024. Facility staff however confirmed that professional coaching was immediately provided to one staff member involved and that one of the two staff members involved was terminated and no longer works at the facility. Additionally, resident interviews conducted did not corroborate that the argument resulted in effectively creating an unfavorable or unsafe environment for the residents in care.

As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

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: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2