306000622-8-13-2021-22-AS-SSAS-C9CVPD-20211203153634

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000622
Report Date: 08/13/2021
Date Signed: 08/13/2021 11:26:57 AM

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
07/16/2020 and conducted by Evaluator Michelle Reed

COMPLAINT CONTROL NUMBER: 22-AS-20200716161947

FACILITY NAME:	ARCENE GUEST HOME II		FACILITY NUMBER:	306000622
ADMINISTRATOR:	MAILA ENRIQUEZ		FACILITY TYPE:	740
ADDRESS:	508 MICHEL PLACE		TELEPHONE:	(714) 996-4717
CITY:	PLACENTIA	STATE: CA	ZIP CODE:	92870
CAPACITY:	6	CENSUS: 2	DATE:	08/13/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Maila Enriquez		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Resident sustained unexplained injury
Resident denied privacy
Resident denied phone calls

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Michelle Reed made an unannounced visit to the facility for the purpose of presenting the findings of the complaint investigation. Upon arrival, LPA met with Administrator Maila Enriquez. The investigation consisted of interviews with Administrator and witnesses as well as documentation. The following was determined:

Resident #1 was admitted into the facility on 4/18/17. In August of 2017, The Orange County Public Guardian’s Office was appointed as Conservator over R1. According to the court ruling and documents provided by Ms. Enriquez, the Public Guardian was granted exclusive authority to manage, direct and make healthcare decisions for R1. On 7/30/20, instructions were given to not allow in person visits by family. Weekly phone calls were to be conducted on Wednesday’s between 6 and 7pm and for no longer then 10 minutes. Phone calls were to monitored/documented to ensure that R1 was not subject to any undue stress and could be terminated if R1 became agitated or distressed. Family were allowed to visit R1 when R1 attended a Senior Center Monday-Friday. Due to closures of the Senior Center during Covid19,

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michelle Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

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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Control Number 22-AS-20200716161947

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: ARCENE GUEST HOME II	FACILITY NUMBER: 306000622
	VISIT DATE: 08/13/2021

NARRATIVE

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facetime calls were approved for the weekly Wednesday calls. If calls were unable to be connected via facetime then regular phone calls would be made. It is unknown what injury complainant was referring to. The injury that was cited was from a year prior due to a fall. Medical treatment was obtained.

Based upon interviews and a review of records, the allegations above are unfounded, meaning the allegations are false, could not have happen or are without a reasonable basis. Administrator and staff were following the direction of R1’s Public Guardian. We have therefore dismissed the complaint.

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

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michelle Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC9099 (FAS) - (06/04)

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