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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004058
Report Date: 01/27/2022
Date Signed: 01/27/2022 11:38:04 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
01/21/2022 and conducted by Evaluator Albert Marin
COMPLAINT CONTROL NUMBER: 22-AS-20220121124308
FACILITY NAME:INFINITY HOME CAREFACILITY NUMBER:
306004058
ADMINISTRATOR:DINA LUCACIUFACILITY TYPE:
740
ADDRESS:26051 CAMINO ADELANTOTELEPHONE:
(949) 859-6019
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 5DATE:
01/27/2022
UNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Administrator Dina LucaciuTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff yelled at resident while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility. LPA met with Administrator (AD) Dina Lucaciu and stated the purpose of the visit and the allegation stated above.

LPA conducted a tour of the interior and exterior portions of the facility. LPA observed five residents and two staff members on the floor. LPA inspected resident's rooms and common areas. LPA conducted a file review and interviews.

Based on observation and interviews, residents in care have varying degree of medical conditions and needs. Due to their medical conditions, staff members need to speak louder to communicate with the residents. All seven witnesses interviewed denied any staff member yell at a resident in any time.

This agency has investigated the complaint alleging staff yelled at a resident while in care. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

LPA Marin conducted a exit interview with AD Lucaciu; and copy of this report was left in the facility
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
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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