306005256-7-23-2024-22-AS-AJLO-D87SVT-20240816141315

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005256
Report Date: 07/23/2024
Date Signed: 07/23/2024 01:58:06 PM

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
07/17/2024 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240717091445

FACILITY NAME:	HEARTWELL CARE VILLA		FACILITY NUMBER:	306005256
ADMINISTRATOR:	ALIPIO JR, IRENEO D		FACILITY TYPE:	740
ADDRESS:	5591 NORMA DRIVE		TELEPHONE:	(714) 606-1087
CITY:	WESTMINSTER	STATE: CA	ZIP CODE:	92683
CAPACITY:	4	CENSUS:	DATE:	07/23/2024
		UNANNOUNCED	TIME BEGAN:	01:01 PM
MET WITH:	Davidson Alipio		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Staff yell at resident(s) in care.
Staff are preventing resident from making phone calls.

INVESTIGATION FINDINGS:

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Regarding the allegation: Staff yell at resident(s) in care.

6 of 10 individuals interviewed denied the complaint allegation above, including all the staff who were interviewed and one witness. R1 denied the allegation and said, “I’m happy.” According to multiple staff members interviewed, Resident 1 (R1) can be hard of hearing and sometime staff will raise their voice to communicate with the resident. Staff 1 says, R1 has a hard time hearing so staff will elevate their voice because R1 is hard of hearing. Staff 2 (S2) said, verbal abuse is a big no no… but sometimes staff do raise their voice because R1 is hard of hearing and there’s a language barrier. S2 explained R1’s native language and the barrier to communicating with the resident. A review or R1’s preplacement appraisal dated August 10, 2022, states R1 has hearing aids, but does not like to wear them.

Continued on LIC9099C

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

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-20240717091445

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: HEARTWELL CARE VILLA	FACILITY NUMBER: 306005256
	VISIT DATE: 07/23/2024

NARRATIVE

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Regarding the allegation: Staff are preventing resident from making phone calls.

6 of 10 individuals interviewed denied the complaint allegation above, including all the staff who were interviewed and one witness. While interviewing R1, the resident pointed to the phone R1 uses (in the facility office area) to call family. Witness 1 (W1) stated when R1 needs to use the phone, the facility staff will call W1 for the resident. W1 continued and said R1’s phone access is limited because R1 previously had a cell phone, but the resident made too many calls and would talk nonsense. Staff 3 (S3) stated when R1 needs to use the phone, the resident has numbers written on a piece of paper and the resident will bring the paper to the staff, tell them who the resident wishes to speak to and the staff will dial the number for R1.

Based on the information gathered through interviews, document review, and observation the following allegations: Staff yell at resident(s) in care, and Staff are preventing resident from making phone calls are deemed unfounded, meaning the allegations are false, could not have happened and/or are without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

LIC9099 (FAS) - (06/04)

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