306002987-1-11-2023-22-AS-SSAS-CN23SQ-20230112173044

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002987
Report Date: 01/11/2023
Date Signed: 01/11/2023 12:40:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
02/16/2022 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220216120250

FACILITY NAME:	MISSION VIEJO CARE COTTAGES 2		FACILITY NUMBER:	306002987
ADMINISTRATOR:	MIGUELITO "BING" FAJARDO		FACILITY TYPE:	740
ADDRESS:	24142 DELPHI STREET		TELEPHONE:	(949) 297-8948
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 6	DATE:	01/11/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Cristina Hilario, caregiver Dominador Tuyong, caregiver Miguelito Fajardo, Administrator (via phone)		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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1/ Resident was sexually abused while in care.

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced inspection visit to follow up on the investigation of the allegation listed above and deliver findings in the investigation. LPA was greeted and granted entry by Cristina Hilario, caregiver after explaining the purpose of the visit. Administrator Miguelito Fajardo was notified by phone and informed of the the allegation being investigated. Administrator was unable to attend the visit but agreed to go over the report by telephone before allowing his caretaking staff to sign on his behalf.

It was alleged that Resident was sexually abused while in care. During the course of the investigation, the Department interviewed the administrator, two (2) members of staff, two (2) residents and four (4) witnesses as well as reviewed and obtained pertinent documentation including resident records along with the Orange County Sheriff Department Police report. LPA conducted two site visits at the facility investigating the allegation on 02/24/2022 and 01/11/2023 and was able to observe the residents in care interacting with staff present also. CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

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-20220216120250

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MISSION VIEJO CARE COTTAGES 2	FACILITY NUMBER: 306002987
	VISIT DATE: 01/11/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099

Regarding the allegation that Resident was sexually abused while in care the following was concluded: On 02/16/2022, resident R1 stated to Acacia Hospice staff that one specific caregiver at the facility was touching him inappropriately, prompting hospice service staff to file a report and complaint with the Department as well as notify law enforcement. On 02/17/2022, a Detective was dispatched and spoke to all interested parties. The content of the interviews was documented in report #22-005215, quoted in an attached form LIC812. According to multiple hospice staff interviewed, Resident R1 was removed from the facility the same day and moved to a different facility.

Multiple witnesses accounts gathered during the investigation corroborate that even caregiver S1 may have been "a little rough" in his handling of resident R1 during transfers and assistance of activities of daily living, there is no evidence that contact was made with the intent of sexual gratification. Other residents (two out of two) and witnesses and staff members interviewed confirmed that they had not observed or obtained knowledge of any evidence attesting to the contrary or that they would have any first-hand or reported knowledge of anything of concern regarding the care being dispensed to the individuals in care

Based on the evidence gathered during the investigation, the allegation that Resident was sexually abused while in care is deemed to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted with the facility representative over the phone and a copy of this report was left at the facility after caregiver Cristina Hilario was able to sign the report.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

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