306006344-1-30-2024-22-AS-SSAS-D2EVRN-20240213154009

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006344
Report Date: 01/30/2024
Date Signed: 01/30/2024 02:45:36 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
01/24/2024 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240124122534

FACILITY NAME:	COGIR OF BREA		FACILITY NUMBER:	306006344
ADMINISTRATOR:	FAYE, SAMUEL		FACILITY TYPE:	740
ADDRESS:	700 MADISON WAY		TELEPHONE:	(714) 681-0105
CITY:	BREA	STATE: CA	ZIP CODE:	92821
CAPACITY:	110	CENSUS: 26	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	11:53 AM
MET WITH:	Charles Luetto- Community Relations Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff do not ensure that client is adequately fed
Staff do not ensure that client's hygiene needs are met
Staff do not keep client's room clean or sanitary

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced 10-day visit to the facility and to deliver the findings. LPA De Perio explained the purpose of today's visit, and was greeted by Community Relations Director – Charles Luetto.

During the investigation, LPA De Perio toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed.

It was alleged that staff do not ensure that client is adequately fed. 4 out of the 4 resident interviews conducted, did not corroborate with the allegation. 3 out of the 4 resident interviews specified that if a resident does not come down to eat, then staff will knock on their door to remind them, or will bring food to their room. 3 out of the 3 staff interviews conducted, also did not corroborate with the allegation by stating that staff will remind and encourage residents to go to the dining room to eat, however, if a resident refuses in wanting to eat, then staff will not force the resident to do so.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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-20240124122534

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: COGIR OF BREA	FACILITY NUMBER: 306006344
	VISIT DATE: 01/30/2024

NARRATIVE

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Per documentation review, facility offers three meals a day and two snack times, and that the facility dining room hours have an “All Day Dining” from 7:00am-7:00pm. Meal times goes as follows: breakfast (7:00am-10:00am), snack (10:00am), lunch (11:30am-1:00pm), snack (2:00pm) and dinner (4:30pm-6:30pm).

It was alleged that staff do not ensure that client's hygiene needs are met. 3 out of the 4 resident interviews did not corroborate with the allegation by stating that hygiene needs are met. 3 out of the 3 staff interviews conducted, did not corroborate with the allegation by stating that if a resident requires assistance per physician report, there will be a caregiver assigned to that resident to assist with bathing on a weekly basis. 3 out of the 3 staff interviews also stated that if a resident refuses staff assistance, or refuses to bathe, then staff will document the resident refusal. Per physician report of resident 1 (R1), R1 is able to bathe, dress, and groom self. R1 verified via interview that R1 will shower on their own, and does not need assistance.

It was alleged that staff do not keep client's room clean or sanitary. 4 out of the 4 resident interviews did not corroborate with the allegation by stating that the staff do a good job at ensuring rooms are clean and sanitized. 3 out of the 3 staff interviews conducted, did not corroborate with the allegation by stating that housekeeping and maintenance are regularly scheduled for each resident to conduct cleaning, sanitizing, repairs, and laundry, however if a resident refuses, then staff will document it. LPA conducted a tour of R1’s room and observed that the room was clean, no hazards observed, and had clean furniture and bed sheets. LPA also did not observe any stench in room, or rotten food. R1 also specified that housekeeping cleaned on 1/29/24 and will come often to assist R1 with any cleaning and laundry that needs to be completed.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, these allegation are deemed UNSUBSTANTIATED.

An exit interview was conducted with Community Relations Director – Charles Luetto. A copy of this report was provided and explained.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

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