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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005447
Report Date: 09/17/2024
Date Signed: 09/17/2024 04:12:04 PM

Unsubstantiated


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
09/13/2024 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240913124507
FACILITY NAME:LAMBERT HOME CAREFACILITY NUMBER:
306005447
ADMINISTRATOR:ASAWADILO, YANINEEFACILITY TYPE:
740
ADDRESS:8191 LAMBERT DRIVETELEPHONE:
(714) 848-1982
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 6DATE:
09/17/2024
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Administrator, Yaninee AsawadilokchaiTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff unlawfully evicted a resident
INVESTIGATION FINDINGS:
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On this day Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to initiate visit on complaint investigation. LPA was granted entry by staff. LPA discussed purpose of the visit with Administrator Yaninee Asawadilokchai.

During investigation LPA toured facility, conducted interviews with staff & witnesses and gathered pertinent documents such as admission agreement and medical records. It was alleged that "staff unlawfully evicted a resident". Based on information received from interviews and review of documents, investigation revealed that on 8/2/2024 a incident report for Resident 1 (R1) stated R1 went out to hospital per Physician’s orders. Discharge paperwork for St. Catherine Healthcare stated that R1 was to be discharged/transferred back to residential care facility Lambert Home Care on 8/21/24. Incident Report dated 8/30/24 states that R1 received new order to be sent out to Skilled Nursing facility for additional labs and physical therapy.

CONTINUED ON 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
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-20240913124507
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: LAMBERT HOME CARE
FACILITY NUMBER: 306005447
VISIT DATE: 09/17/2024
NARRATIVE
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Interview conducted with witness states that during R1’s discharge on 8/21/24 witness claims Facility stated they were not going to be accepting back R1 at first and then later confirmed they would accept R1. Facility discharge paperwork confirms R1 was accepted back to facility.

Interviews conducted with staff confirmed that two of two staff stated R1 was sent back out to skilled nursing facility on 8/30/24 per Physician. Interview with Administrator stated that Physician mentioned to Administrator that R1’s family was informed of the new order. Interview with witness confirmed that family was made aware of Physician’s order for R1 to go back to skilled nursing for additional evaluation. Interviews with staff confirmed that no residents have been given eviction notices or denied entry back to facility. Interview with Resident 2 (R2) confirms they have never been asked to vacate facility or given eviction notice during their time in facility. As of today’s visit LPA was unable to interview R1 due to R1 was not present during visit and was confirmed to still be at skilled nursing facility. Interviews conducted with staff and witness confirm that arrangements for R1 are scheduled to be discharged from skilled nursing facility on 9/19/24. Interview with Administrator states that skilled nursing will arrange transportation for R1 back to facility.

Based off information received, timeline of events and conflicting reports, the complaint allegation staff unlawfully evicted a resident is deemed UNSUBSTANTIATED, meaning although the allegations may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violations occurred as reported.

An exit interview was conducted and a copy of this report along with a LIC 811 confidential name list was left at the facility.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2