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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300611830
Report Date: 08/17/2023
Date Signed: 08/17/2023 12:30:51 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/01/2023 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230801161429
FACILITY NAME:CAMBRIDGE HOUSEFACILITY NUMBER:
300611830
ADMINISTRATOR:EVELYN WALLACEFACILITY TYPE:
740
ADDRESS:1895 NORTH CAMBRIDGETELEPHONE:
(714) 637-3911
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY:6CENSUS: 5DATE:
08/17/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Irene Sheilds- Caregiver TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff are not allowing family to visit resident
INVESTIGATION FINDINGS:
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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by caregiver Irene Sheilds, and explained the reason for the visit.

The department received a complaint on 08/01/2023 and the initial 10 day visit was conducted on 08/08/2023. LPA Mendivil obtained copies of physician report and admission agreement. LPA interviewed staff and a witness. Regarding the allegation the staff are not allowing family to visit resident, the investigation revealved the following:

Based on conversations with Licensee/Administrator Evelyn Wallace, Administrator stated they have not denied anyone visitations. Administrator reported that they have allowed all residents to have visitors.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
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 2
Control Number 22-AS-20230801161429
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CAMBRIDGE HOUSE
FACILITY NUMBER: 300611830
VISIT DATE: 08/17/2023
NARRATIVE
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Based on conversations with a witness it was reported that they have been able to visit their relative, but was told by the facility to contact relative's Power of Attorney prior to visiting, but was not told they could not visit their relative.

Therefore based on the preponderance of evidence through records reviewed and interviews conducted the allegation that Staff are not allowing family to visit resident is determined to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint.
No deficiencies cited.

An exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2