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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006436
Report Date: 11/01/2024
Date Signed: 11/01/2024 08:43:15 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 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
10/08/2024 and conducted by Evaluator Dwayne L Mason
COMPLAINT CONTROL NUMBER: 22-AS-20241008100632
FACILITY NAME:HOMEWOOD BOARD & CARE HOMEFACILITY NUMBER:
306006436
ADMINISTRATOR:HERNANDEZ, MARISAFACILITY TYPE:
735
ADDRESS:6382 HOMEWOOD AVE.TELEPHONE:
(714) 290-3809
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:4CENSUS: 4DATE:
11/01/2024
UNANNOUNCEDTIME BEGAN:
07:06 AM
MET WITH:Andrew Nudo - CaregiverTIME COMPLETED:
08:56 AM
ALLEGATION(S):
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Facility is not following the posted menu.
INVESTIGATION FINDINGS:
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This unannounced investigation inspection by Licensing Program Analyst (LPA) Dwayne Mason Jr. is being conducted to conclude this agency’s investigation in the complaint allegation(s) mentioned above. LPA arrived at the facility and was greeted by Andrew Nudo, Caregiver. LPA spoke with Administrator Marisa Hernandez on the phone and explained the nature of the inspection.

The department received a complaint on 10/8/2024 alleging the facility is not following the posted menu. During the investigation, the department interviewed facility Administrator (AD), staff and clients.

(continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
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 5
Control Number 22-AS-20241008100632
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HOMEWOOD BOARD & CARE HOME
FACILITY NUMBER: 306006436
VISIT DATE: 11/01/2024
NARRATIVE
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(continued from LIC9099)

On 10/17/2024 LPA conducted a visit to the facility to initiate investigation into the above allegation. LPA reviewed the posted menu. LPA observed the menu selections for 10/17/2024: carrots, humus and oranges for snacks, spaghetti and meatballs for lunch and beef with stuffed peppers for dinner. LPA obtained photos of the refrigerator, freezer and pantry contents as well as the posted menu. Based on observations, LPA determined the facility did not have carrots, humus or oranges in the facility on 10/17/2024. Based on interview with one staff and the administrator, the facility did not have the ingredients for the stuffed peppers that night. Based on interview with one staff and the administrator, the post menu does not reflect all of the meals that end up being served. Based on interview with Administrator, the selections posted for lunch indicate the meals facility staff plan to prepare for clients to take with them to Day Program for lunch.

On 11/1/2024, LPA returned to the facility. LPA obtained a photo of the current week's menu and conducted interviews with Administrator, staff and clients. Based on interviews with 4 clients, 4 out of 4 stated the facility is following the posted menu. LPA observed 4 out of 4 clients having a sausage croissant sandwich and fruit for breakfast. On this day the posted menu indicated clients would be having a breakfast egg sandwich and fruit for breakfast. Based on interviews with one staff and four clients, one staff and three clients stated the facility had spaghetti and toast for dinner on 10/31/2024. The planned dinner for 10/31/2024 on the posted menu reads "Hamburger choice of toppings salad w/ carrots and cucumbers"

Based on interviews conducted, records reviewed and observations made, LPA determined that the facility is not following the posted menu as outlined by the above Title 22 Regulation. LPA observed items necessary for some 10/17/2024 posted menu selections were not present in the facility on 10/17/2024. Staff and clients stated dinner served on 10/31/2024 was a meal that was not posted on the menu for 10/31/2024 dinner.

The preponderance of evidence standard has been met. The allegation of Facility is not following the posted menu is determined to be SUBSTANTIATED, meaning the complaint allegation is valid and that a violation has occurred. An exit interview was conducted, and this report was reviewed with facility staff. A copy of this LIC-9099, deficiency page and appeal rights were provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
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 5
Control Number 22-AS-20241008100632
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HOMEWOOD BOARD & CARE HOME
FACILITY NUMBER: 306006436
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2024
Section Cited
CCR
80076
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80076(a)( 5) Menus shall be written at least one week in advance and copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the clients or their authorized representatives and the licensing agency upon request.
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Administrator stated they will ensure the menu is followed as posted. LPA stated they will verify the plan of corrections at an unannounced follow up visit.
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The Licensee did not comply with the section cited above due to verifiable changes to the menu made on 10/17/24 and 10/31/24. The changes were verified via interviews with facility staff and clients as well as observations of the posted menu and food inventory in the facility.
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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: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 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
10/08/2024 and conducted by Evaluator Dwayne L Mason
COMPLAINT CONTROL NUMBER: 22-AS-20241008100632

FACILITY NAME:HOMEWOOD BOARD & CARE HOMEFACILITY NUMBER:
306006436
ADMINISTRATOR:HERNANDEZ, MARISAFACILITY TYPE:
735
ADDRESS:6382 HOMEWOOD AVE.TELEPHONE:
(714) 290-3809
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:4CENSUS: 4DATE:
11/01/2024
UNANNOUNCEDTIME BEGAN:
07:06 AM
MET WITH:Andrew Nudo - CaregiverTIME COMPLETED:
08:56 AM
ALLEGATION(S):
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Facility does not have enough food.
Facility is not providing well balanced nutritious meals.
INVESTIGATION FINDINGS:
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This unannounced investigation inspection by Licensing Program Analyst (LPA) Dwayne Mason Jr. is being conducted to conclude this agency’s investigation in the complaint allegation(s) mentioned above. LPA arrived at the facility and was greeted by Andrew Nudo, Caregiver. LPA spoke with Administrator Marisa Hernandez on the phone and explained the nature of the inspection.

The department received a complaint on 10/8/2024 alleging the facility does not have enough food and facility is not providing well balanced nutritious meals. During the investigation, the department interviewed facility Administrator (AD), staff and clients.

(continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
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: 4 of 5
Control Number 22-AS-20241008100632
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: HOMEWOOD BOARD & CARE HOME
FACILITY NUMBER: 306006436
VISIT DATE: 11/01/2024
NARRATIVE
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(continued from LIC9099)

On 10/17/2024 LPA conducted a visit to the facility to initiate investigation into the above allegation. LPA obtained photos of the personnel report dated 8/1/2024, client roster dated 8/1/2024, Pre-placement appraisals, posted menu and grocery store receipts for the month of October. LPA also made observations of the facility refrigerator, freezer and pantry. Based on review of client appraisals, zero out of four clients have special diet needs. One out of four clients is listed as a "picky eater."

On 11/1/2024, LPA returned to the facility. LPA conducted interviews with AD, staff and clients. Based on interviews conducted, 1 out of 4 clients stated the facility "sometimes does not have enough food".1 out of 4 clients stated the facility is not providing well balanced nutritious meals. Based on interview with AD, facility bought groceries on 10/30/2024. LPA obtained photos of the refrigerator, freezer and pantry. LPA observed fruit, vegetables, grains, meats, dairy, drinks, water, snacks and more. LPA obtained photos of the breakfast served on 11/1/2024. LPA observed clients eating microwaveable breakfast sandwiches and fresh fruit. LPA observed both microwaveable foods as well as fresh meat and produce present in the facility.

Based on interviews conducted, records reviewed and observations made, LPA determined that the facility does have enough food and are providing well balanced nutritious meals. LPA did observe some microwaveable meals, however LPA also observed fresh ingredients. LPA advised facility to avoid relying on microwaveable meals too often. Administrator, Staff and 3 out of 4 clients denied the allegations.

Based on interviews conducted and records reviewed there is insufficient evidence to support the allegation(s). Although the allegation(s) may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted, and this report was reviewed with facility staff. A copy of this LIC-9099 was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
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: 5 of 5