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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004323
Report Date: 10/13/2023
Date Signed: 10/19/2023 10:10:23 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
10/10/2023 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231010142329
FACILITY NAME:MEISON LA PAZ IFACILITY NUMBER:
306004323
ADMINISTRATOR:SAKVADOR DIAZ JRFACILITY TYPE:
740
ADDRESS:25421 MARINA CIRCLETELEPHONE:
(949) 859-5049
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 5DATE:
10/13/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jennifer Perez, AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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9
Uncleared staff providing care and supervision to residents.

Staff did not safeguard resident’s money.
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the allegations listed above. LPA was greeted and granted entry by caregiving staff after stating the purpose of the visit. Administrator Jennifer Perez was notified of the visit via telephone and arrived later to assist with the visit. LPA listed the allegations investigated during the initial phone conversation.

During the visit, LPA requested and obtained records for former resident R1. LPA reviewed the facility's admission agreement and its section on theft and loss, the facility's theft and loss policy as well as the inventory established upon admission. The list of all facility employees was additionally provided by the facility administrator.

CONTINUED ON FORM LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
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-20231010142329
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: MEISON LA PAZ I
FACILITY NUMBER: 306004323
VISIT DATE: 10/13/2023
NARRATIVE
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CONTINUED FROM LIC9099

Regarding the allegation that Uncleared staff providing care and supervision to residents, the following has been concluded: Based on interviews with administrator and staff members along with a review of the current facility roster, all individuals involved in providing care for residents were shown to be cleared and associated to the facility. The allegation is therefore determined to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

Regarding the allegation that Staff did not safeguard resident’s money, the following has been concluded: Based on a review of the terms of the admission agreement, facility theft and loss policy and the inventory of safeguarded cash and valuables filled by resident R1 upon admission, it was determined that the alleged missing funds were not placed under the facility's safeguarding responsibility. Additionally, the terms of the admission agreement indicate that "The Company is not responsible for any cash, valuables or personal property brought into the facility unless these items are delivered to the licensee/administrator for safeguarding". As evidenced by the three pages of inventorized property present in R1's records, cash funds were not placed under the facility's responsibility during the period the resident was admitted at the facility. As a result, the allegation is found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC9099 (FAS) - (06/04)
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