421703604-4-7-2022-29-AS-KBUY-CDGP2X-20220414105641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 421703604
Report Date: 04/07/2022
Date Signed: 04/07/2022 01:28:11 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/01/2022 and conducted by Evaluator Toan Luong

COMPLAINT CONTROL NUMBER: 29-AS-20220401130410

FACILITY NAME:	ORCUTT BOARD AND CARE HOME		FACILITY NUMBER:	421703604
ADMINISTRATOR:	ANNIE YAGUE		FACILITY TYPE:	740
ADDRESS:	263 CRESCENT AVE.		TELEPHONE:	(805) 934-2586
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	6	CENSUS: 3	DATE:	04/07/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Nelson Yague		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident was not allowed access to personal belongings
Resident was not treated with dignity

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Toan Luong conducted an unnannounced complaint visit to Orcutt Board and Care Home. LPA met with Administrator Nelson Yague and explained the purpose of the visit. LPA conducted a welfare tour of the facility.
LPA conducted interviews from 10:15 a.m. to 12:10 p.m. with 3 out of 3 residents, staff, and witnesses.

Allegtaion #1: Resident was not allowed access to personal belongings
LPA's interviews reveal that Resident #1 (R1) will routinely make requests to staff about access to money in a trust fund. Staff do not have the scope to access R1's funds resulting in agitation to R1. R1 has made numerous requests to friend and responsible parties via phone calls to access funds in the trust. Friend and parties do not have the authority to complete R1's request resulting in addtional agitation. Friend and responsible parties have requested the facility to temporarily withhold R1's phone after R1 has made numerous consecutive calls to them in regards to the trust. R1 has also contacted 911 within the same period to report minor issues. (Continued on 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Toan Luong	TELEPHONE: (626) 419-1827
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

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 29-AS-20220401130410

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ORCUTT BOARD AND CARE HOME	FACILITY NUMBER: 421703604
	VISIT DATE: 04/07/2022

NARRATIVE

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R1 has reasonable access to the phone. R1 is conserved. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur based on LPA's interviews, therefore the allegation is unsubstantiated.

Allegation #2 Resident was not treated with dignity.
During LPA's interview, LPA was unable to corroborate interviews with each other to support the allegation. Interview with one resident and resident's closest friend contradict description of caregivers at the facility. Interviews among remaining residents, witnesses, and staff do not support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur based on LPA's interviews, therefore the allegation is unsubstantiated.

LPA conducted exit interview and emailed a copy of the report to the administrator.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Toan Luong	TELEPHONE: (626) 419-1827
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

LIC9099 (FAS) - (06/04)

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