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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 05/15/2024
Date Signed: 05/15/2024 05:24:53 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
05/09/2024 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240509144506
FACILITY NAME:ANAHEIM PALACEFACILITY NUMBER:
306006452
ADMINISTRATOR:CHON, CHRISTINE MFACILITY TYPE:
740
ADDRESS:525 W. LA PALMA AVETELEPHONE:
(626) 252-7287
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:199CENSUS: 180DATE:
05/15/2024
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Yaylene MazariegosTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility does not have a qualified Administrator
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 Assistant Administrator Yaylene Mazariegos and explained the reason for the visit. The investigation revealed the following. It was alleged that the facility does not have an Administrator who has a current Administrator's certificate. The former Administrator stopped working for the facility on May 3, 2024. LPA verified this information with the former Administrator. The Licensing Program Analyst assigned to the facility did not receive a new LIC 308, designation of facility responsibility, along with the prospective Administrator's valid certificate, naming the new Administrator. LPA interviewed 2 facility staff who verified the facility does not have an Administrator who has a current Administrator's certificate. No information was provided to the Agency regarding a new Administrator. From May 4, 2024 to the date of this report, May 15, 2024 the facility does not have a currently certified Administrator. Based on the information gathered the preponderance of evidence standard has been met, therefore, the allegation, is deemed substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
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-20240509144506
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: ANAHEIM PALACE
FACILITY NUMBER: 306006452
VISIT DATE: 05/15/2024
NARRATIVE
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Violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report along with citation and Appeal Rights was provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20240509144506
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: ANAHEIM PALACE
FACILITY NUMBER: 306006452
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2024
Section Cited
CCR
87405(a)
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87405(a)Administrator - Qualifications and Duties:(a)All facilities shall have a qualified and currently certified administrator...
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Licensee agrees to hire a qualified and currently certified administrator and to submit the required documentation for the new administrator to the LPA by the POC due date.
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This requirement is not being met as evidenced by, through a record review and interviews it was demonstrated that the facility does not a qualified and currently certified administrator. This poses a potential health and safety risk to 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.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC9099 (FAS) - (06/04)
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