<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 08/29/2024
Date Signed: 08/29/2024 02:05:26 PM

Unsubstantiated


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
06/10/2024 and conducted by Evaluator Dwayne L Mason
COMPLAINT CONTROL NUMBER: 22-AS-20240610155726
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: 195DATE:
08/29/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Susan Lee - Executive DirectorTIME COMPLETED:
02:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has trip hazards in the dining room and kitchen.
Facility is not maintained at a comfortable temperature for residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 met with Susan Lee, Executive Director and explained the nature of the inspection.

The department received a complaint on 6/10/2024 stating facility has trip hazards in the dining room and kitchen and that facility is not maintained at a comfortable temperature for residents in care. During the investigation, the department interviewed Executive Director (ED), staff and residents in care.

On 6/14/2024 LPA conducted a visit to the facility. In regards to the allegation of facility has trip hazards in the dining room and kitchen, LPA toured the facility and observed an aisle in the kitchen between appliances and food storage. Facility staff occupy this aisle while preparing food.

(continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
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
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
06/10/2024 and conducted by Evaluator Dwayne L Mason
COMPLAINT CONTROL NUMBER: 22-AS-20240610155726

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: 195DATE:
08/29/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Susan Lee - Executive DirectorTIME COMPLETED:
02:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not store food properly
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 met with Susan Lee, Executive Director and explained the nature of the inspection.

The department received a complaint on 6/10/2024 stating facility does not store food properly. During the investigation, the department interviewed Executive Director (ED), staff and residents in care.

(continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20240610155726
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: ANAHEIM PALACE
FACILITY NUMBER: 306006452
VISIT DATE: 08/29/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(continued from LIC9099)

On 6/14/2024 LPA conducted a visit to the facility. LPA obtained copies of: resident roster dated 6/11/2024, menu for the month of June and facility food service policy. LPA toured the facility and interviewed staff and residents in care. Staff and Residents made no disclosures regarding the allegation. Staff stated the facility always adheres to regulations regarding food storage and preparation.

On 8/20/2024, LPA returned to the facility. LPA obtained copies of the facility’s 8/19/2024 invoice for U.S. Food and the receipts for the grocery store.

In regards to the allegation of facility does not store food properly, LPA observed food to be improperly stored in the facility kitchen. LPA observed kim chi, broccoli and rice stored in uncovered in buckets without lids in the refrigerator. LPA observed metal containers with beef partially covered with plastic. LPA observed slices of cheesecake stored in the refrigerator uncovered. Per regulation, all readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. LPA observed refrigerator temperature to be 46.8 degrees Fahrenheit. LPA observed freezer temperature to be -8 degrees Fahrenheit. Per regulation, Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. LPA conducted interview with ED. ED stated the facility has contract with U.S. Food (USF). LPA conducted interviews with Staff and Residents. Staff and Residents stated they have not seen or heard of any other residents or staff falling or tripping in the dining room or kitchen.

During the investigation, there was sufficient evidence to substantiate the allegation of facility does not store food properly. Based on observations made and photos obtained, the preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED. See LIC9099-D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations

An exit interview was conducted, and this report was reviewed with ED. 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: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20240610155726
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: ANAHEIM PALACE
FACILITY NUMBER: 306006452
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/12/2024
Section Cited
CCR
87555(b)(21)
1
2
3
4
5
6
7
87555 General Food Service Requirements
(21) Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C). They shall be kept clean and food stored to
1
2
3
4
5
6
7
Executive Director stated they will have kitchen staff adjust refrigerator temperature. LPA will verify the plan of correction via plan of corrections visit.
8
9
10
11
12
13
14
enable adequate air circulation to maintain the above temperatures.
Based on observations, the Licensee did not comply with the regulation cited above due to the refrigerator temperature being set to 46.8 degrees F. This creates a potential health risk to persons in care.
8
9
10
11
12
13
14
Type B
09/12/2024
Section Cited
CCR
87555(b)(23)
1
2
3
4
5
6
7
87555 General Food Service Requirements
(23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures.
1
2
3
4
5
6
7
Executive Director stated they will work with the kitchen staff to continually store food properly according to Title 22 Regulations and hold an in-service training on food storage and preparation. ED stated they will email LPA documentation reflecting the training.
8
9
10
11
12
13
14
Based on observations, the Licensee did compy with the regulation cited above due to LPA observations of five perishable foods being uncovered in the kitchen.
8
9
10
11
12
13
14
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: 08/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20240610155726
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: ANAHEIM PALACE
FACILITY NUMBER: 306006452
VISIT DATE: 08/29/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(continued from LIC9099)

LPA measured aisle to be 43.5 inches wide. LPA observed a two-burner stove that extends into the aisle by
17.5 inches. LPA measured the distance from the front face of the two-burner oven to the shelf of food across from it. The aisle measured 26 inches. LPA conducted interviews with residents in care who stated that they do not enter the kitchen as it is an off-limits area to them. Residents also stated they have never seen or heard about tripping or falling in the dining room or kitchen. LPA also interviewed kitchen staff. Kitchen staff stated they have not tripped or heard of any staff report that they tripped in the kitchen. Kitchen staff stated that they have not heard of any staff or resident tripping in the dining room. Kitchen staff stated they feel like they have enough room to safely navigate the aisle.

In regards to the allegation of facility is not maintained at a comfortable temperature for residents, LPA interviewed staff and residents in care. LPA observed three thermostats in the facility. The first floor thermostat is located between rooms A105 and A107 and was observed at 74 degrees Fahrenheit. The second floor thermostat is located between rooms A213 and A215 and was observed at 76 degrees Fahrenheit. The third floor thermostat is located between rooms A317 and A315 and was observed at 77 degrees Fahrenheit. During interviews conducted, six of the seven residents interviewed stated the temperature in the facility is comfortable. All staff interviewed stated the temperature in the facility is comfortable. All staff interviewed stated the temperature in the facility is comfortable. LPA obtained photos of the thermostats throughout the facility.

LPA obtained copies of the following files: resident roster dated 6/11/2024, personnel contact list and facility floor plan.

Based on record review and interviews conducted with ED, staff and residents, LPA determined that the facility does not have tripping hazards in the dining room and the facility is maintained at a comfortable temperature for residents. Based on interviews conducted and records reviewed there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid; there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted, and this report was reviewed with ED. 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: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5