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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608858
Report Date: 05/28/2021
Date Signed: 05/28/2021 01:31:11 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., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/19/2021 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 31-AS-20210519143752
FACILITY NAME:ANGEL'S CARING HOMEFACILITY NUMBER:
197608858
ADMINISTRATOR:DANIEL D. CHOFACILITY TYPE:
740
ADDRESS:23747 VIA GAVOLATELEPHONE:
(661) 287-4526
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY:5CENSUS: 4DATE:
05/28/2021
UNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Daniel Cho - AdministratorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff does not allow resident's to have visitors
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit to this facility to investigate the above allegation. LPA initially met with staff Vincent Portunes. Administrator Daniel Cho was called and arrived twenty (20) minutes later.

LPA conducted physical plant tour at 9:05 AM. At 9:50 AM, LPA interviewed staff. At 10:10 AM, LPA interviewed the administrator and residents. LPA interview with Resident #1 (R1) and Resident # 2 (R2) revealed that the facility allowed their family to visit inside the facility. LPA also attempted to interview two (2) other residents but one (1) was asleep during the duration of the visit and the other was at a medical appointment. LPA interview with the administrator also revealed that the "No visitor" sign was still posted on the door for general public view but family members and essential visitors are allowed to enter per the existing guideline. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.
Exit interview conducted. Copy of this report issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021
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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