331800205-3-29-2023-18-AS-JESL-CQEP7E-20230330110350

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800205
Report Date: 03/29/2023
Date Signed: 03/29/2023 12:21:52 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/16/2020 and conducted by Evaluator Jesse Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201216140053

FACILITY NAME:	HAPPY LIFE HEALTH CARE		FACILITY NUMBER:	331800205
ADMINISTRATOR:	NA ZHAO		FACILITY TYPE:	740
ADDRESS:	30667 BROOKSTONE LN		TELEPHONE:	(951) 226-7644
CITY:	LAKE ELSINORE	STATE: CA	ZIP CODE:	92530
CAPACITY:	0	CENSUS: 0	DATE:	03/29/2023
		UNANNOUNCED	TIME BEGAN:	11:56 AM
MET WITH:	Brandon Marquez, Acting Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility failed to seek medical attention.
Facility is in disrepair.
Facility failed to report a Covid outbreak.
Facility failed to issue a refund for rent.
Facility restricted visitations.
Facility did not return resident's personal belongings.

INVESTIGATION FINDINGS:

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On March 29, 2023, Licensing Program Manager (LPM) Joel Esquivel and Licensing Program Analyst (LPA) Jesse Gardner met with acting Administrator Brandon Marquez for an office meeting to discuss the above allegations.

Regarding allegation; Facility failed to seek medical attention. Licensing Program Manager (LPM) Joel Esquivel met with acting Administrator Brandon Marquez to discuss the allegation noted. Acting Administrator denied that Facility failed to seek medical attention.

Continued on LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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 18-AS-20201216140053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: HAPPY LIFE HEALTH CARE	FACILITY NUMBER: 331800205
	VISIT DATE: 03/29/2023

NARRATIVE

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Administrator stated that staff would provide care as needed and hospice was also current on their visits and care provided. The facility has been closed as of November 4, 2021. LPM was unable to interview staff, or residents. Due to the lack of evidence and unable to interview staff or residents the allegation is thereby deemed as Unsubstantiated.

Regarding allegation; Facility is in disrepair. Licensing Program Manager (LPM) Joel Esquivel met with acting Administrator to discuss the allegation noted. Acting Administrator denied that the facility was in disrepair. Administrator stated that staff would clean the facility on regular basis and had not mentioned any such issue mentioned. The facility has been closed as of November 4, 2021. LPM was unable to interview staff, or residents. Due to the lack of evidence and unable to interview staff or residents the allegation is thereby deemed as Unsubstantiated.

Regarding allegation; Facility failed to report a Covid outbreak. Licensing Program Manager (LPM) Joel Esquivel met with acting Administrator to discuss the allegation noted. Acting Administrator denied that the facility failed to report a Covid outbreak. Administrator stated that staff during this time the facility had to take all precautions and provide the best care possible and the facility did not have an outbreak. The facility has been closed as of November 4, 2021. LPM was unable to interview staff, residents or review the facility. Due to the lack of evidence and unable to interview staff or residents the allegation is thereby deemed as Unsubstantiated.

Regarding allegation; Facility failed to issue a refund for rent. Licensing Program Manager (LPM) Joel Esquivel met with acting Administrator to discuss the allegation noted. Acting Administrator denied providing a refund as required. The facility has been closed as of November 4, 2021. LPM was unable to interview staff, residents or review the facility. Due to the lack of evidence and unable to interview staff or residents the allegation is thereby deemed as Unsubstantiated.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20201216140053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: HAPPY LIFE HEALTH CARE	FACILITY NUMBER: 331800205
	VISIT DATE: 03/29/2023

NARRATIVE

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Regarding allegation; Facility restricted visitations. Licensing Program Manager (LPM) Joel Esquivel met with acting Administrator to discuss the allegation noted. Acting Administrator stated that the facility was under pressure to maintain a healthy environment for all residents and were simply following County Health Department guidelines. Administrator stated that staff during this time the facility had to take all precautions and provide the best care possible. The facility has been closed as of November 4, 2021. LPM was unable to interview staff, residents or review the facility. Due to the lack of evidence and unable to interview staff or residents the allegation is thereby deemed as Unsubstantiated.

Regarding allegation; Facility did not return resident's personal belongings. Licensing Program Manager (LPM) Joel Esquivel met with acting Administrator to discuss the allegation noted. Acting Administrator denied not returning resident’s personal belongings. Administrator stated that staff placed all belongings in the garage, and no one came by to pick up belongings. The facility has been closed as of November 4, 2021. LPM was unable to interview staff, residents or review the facility. Due to the lack of evidence and unable to interview staff or residents the allegation is thereby deemed as Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to the licensee/ Administrator Na Zhao.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-8031
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC9099 (FAS) - (06/04)

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