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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006288
Report Date: 11/01/2024
Date Signed: 11/01/2024 05:01:41 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
11/01/2024 and conducted by Evaluator Joseph Alejandre
COMPLAINT CONTROL NUMBER: 22-AS-20241101110953
FACILITY NAME:WE CONQUER TOGETHER LLCFACILITY NUMBER:
306006288
ADMINISTRATOR:MENDEZ, ALBERTFACILITY TYPE:
772
ADDRESS:17367 ASPENGLOW LANETELEPHONE:
(626) 272-4246
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:6CENSUS: 1DATE:
11/01/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Albert MendezTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility did not obtain a completed medical assessment for client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Administrator AlbertMendez and explained the reason for the visit. The investigation revealed the following. It was alleged that the facility did not obtain completed medical assessment for client who was at the facility on October 1, 2024. A review of facility records shows the on October 1, 2024 there was 3 clients at the facility. Client 1 (C1), Client 2 (C2) and Client 3 (C3). A review of client records shows each client had a Nursing Assessment, TB screening, pre-admission screening and History and Physical and Psychiatric Evaluation, 4 separate forms contain different elements of a medical assessment such as diagnosis and medical history, however, none of forms have a determination of the client's ambulatory status. None of the forms meet the requirement of a medical assessment as set forth in California Code of Regulation (CCR) Title 22, Division 6, 81069. A review of Client records shows 3 out of 3 clients at the facility on October 1, 2024 did not have a complete medical assessment. C1, C2 and C3 did not have a complete medical assessments.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
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 3
Control Number 22-AS-20241101110953
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: WE CONQUER TOGETHER LLC
FACILITY NUMBER: 306006288
VISIT DATE: 11/01/2024
NARRATIVE
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Based on the evidence gathered the preponderance of evidence standard has been met, therefore the allegation is substantiated. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20241101110953
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: WE CONQUER TOGETHER LLC
FACILITY NUMBER: 306006288
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2024
Section Cited
CCR
81070(b)(9)
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(b) Each client record shall contain the following information including, but not limited to, the following: (2) Medical assessment, including ambulatory status, as specified in Section 81069. This requirement is not being met as evidenced by;
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Licensee agrees to have a medical assessment (LIC 602) that meets all the regulatory requirements completed for all current and future clients. Licensee agrees to forward a current medical assessment for the client in care at the time of the visit.
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A review client records shows C1, C2 and C3 did not have complete medical assessments. This poses an immediate 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: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3