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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005392
Report Date: 02/06/2024
Date Signed: 02/06/2024 11:43:11 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
01/30/2024 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240130111350
FACILITY NAME:TAYLOR COTTAGE, THEFACILITY NUMBER:
306005392
ADMINISTRATOR:CATACUTAN, MARY JEANFACILITY TYPE:
740
ADDRESS:7752 TAYLOR DRIVETELEPHONE:
(614) 746-5824
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:6CENSUS: 6DATE:
02/06/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Wennie Earwood - LicenseeTIME COMPLETED:
11:55 AM
ALLEGATION(S):
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Facility is refusing to provide resident with a modified diet as prescribed by doctor's orders.
Insufficient staff to meet residents' care needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint received January 30, 2024. LPA Haley was greeted by staff and explained the reason for the visit. Staff contacted licensee Wennie Earwood who arrived a short time later and was present for the remainder of the visit.

Regarding the allegation: Facility is refusing to provide resident with a modified diet as prescribed by doctor's orders.

During the investigation 3 of 3 individuals including the licensee and resident 1 (R1) denied the allegation. R1 has not been prescribed a special diet at this time. In preparation for a medical procedure to take place on a later date that has not been determined, R1 has been on a Low Carb/No Carb diet since November 2023. However, R1 acknowledged his current diet was not prescribed by his physician, but it was highly recommended.
Continued on LIC9099C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
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-20240130111350
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: TAYLOR COTTAGE, THE
FACILITY NUMBER: 306005392
VISIT DATE: 02/06/2024
NARRATIVE
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After R1’s medical procedure, a special diet will be prescribed for six weeks. At this time, the medical procedure has not been scheduled. R1 expects the procedure to be scheduled in late March or early April.

Regarding the allegation: Insufficient staff to meet residents' care needs.

During the investigation 4 of 4 individuals interviewed including the licensee, facility staff, and a facility resident denied the allegation above. According to the Licensee Earwood, staffing is adequate, and the new caregivers are doing a good job. Staff 1 and Staff 2 both agreed that staffing is fine, and they have enough assistance from their partners. Resident 1 (R1) also denied the allegation and is pleased with the caregivers.

During the visit, licensee Earwood provided copies of R1’s physician’s report, Preplacement appraisal, Resident Appraisal, and Postoperative diet instructions and information. The resident roster was emailed to LPA Haley during the visit.



Based on the information gathered through interviews, observation, and document review the following allegations: Facility is refusing to provide resident with a modified diet as prescribed by doctor's orders, and Insufficient staff to meet residents' care needs 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 this report was provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2