306001402-8-5-2022-22-AS-LADS-CHSUHJ-20220830153601

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306001402
Report Date: 08/05/2022
Date Signed: 08/05/2022 05:24:27 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
08/03/2022 and conducted by Evaluator Joseph Alejandre

COMPLAINT CONTROL NUMBER: 22-AS-20220803100051

FACILITY NAME:	ALICIA CARE		FACILITY NUMBER:	306001402
ADMINISTRATOR:	SAEED, MUHAMMAD ANWAR		FACILITY TYPE:	740
ADDRESS:	29742 ANA MARIA		TELEPHONE:	(949) 249-6610
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY:	6	CENSUS: 3	DATE:	08/05/2022
		UNANNOUNCED	TIME BEGAN:	04:16 PM
MET WITH:	Muhammad Saeed		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Facility is not maintaining proper temperature in facility.
Residents needs are not being met resulting in excessive screaming.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA met with Administrator Muhammad Saeed and explained the reason for the visit. The investigation into the allegations revealed the following. It was alleged that resident's needs are not being met resulting in excessive screaming. A resident (R1) at the facility exhibits uncontrollable behaviors that result in screaming and shouting. This was verified through a review of facility medical records and staff interviews. LPA observed all of the residents and heard R1 shouting. LPA did not observe any mistreatment or improper care that would account for the R1 shouting. Administrator reported that R1 shouts and cannot control their actions. Administrator reported the staff make the resident as comfortable as possible and provide proper care. LPA observed the facility is clean and free of obstacles and hazards. The facility has water, hot water, electricity, natural gas and phone service and internet. Facility hospice records show R1 receives regular hospice visits. LPA did not observe any evidence of any resident's needs not being met. Based on the evidence gathered, through record review, observation and interviews the allegation, resident's needs are not being met resulting in excessive screaming, (continued)

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022

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 22-AS-20220803100051

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: ALICIA CARE	FACILITY NUMBER: 306001402
	VISIT DATE: 08/05/2022

NARRATIVE

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is deemed UNFOUNDED, meaning the allegation is false could not have happened and/or is without a reasonable basis.

In regards to the allegation, facility is not maintaining proper temperature in facility, the investigation revealed the following. LPA measured the temperature in the bedroom of R1, in the living room and dining room. The temperature was 80 degrees Fahrenheit. LPA observed the air conditioner turned on during the visit. LPA measured the air coming from the air conditioning vent in R1's bedroom and it was 70 degrees. Administrator reported that the window to R1's room is open sometimes to get fresh air. LPA observed the window was open and there was a fan operating and the air conditioning was on. CCR Title 22 Division 6, Chapter 8 87303(b)(2) states; The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. The facility has air conditioning that is operational and it is cooling the facility. The temperature in the facility is within the regulatory requirements. Based on the information gathered from observation and interviews the allegations, facility is not maintaining proper temperature in facility is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of the report provided.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022

LIC9099 (FAS) - (06/04)

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