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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005478
Report Date: 01/09/2023
Date Signed: 03/02/2023 05:18:39 PM

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
10/12/2021 and conducted by Evaluator Rosie Quiroz
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211012143927
FACILITY NAME:SAINT BENEDICT CARE LLCFACILITY NUMBER:
306005478
ADMINISTRATOR:ALMIRANEZ, ULDARICOFACILITY TYPE:
740
ADDRESS:8925 CANARY AVENUETELEPHONE:
(949) 290-6006
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 6DATE:
01/09/2023
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Kristine Guevarra, Caregiver and Uldarico Almiranez (Via telephone)TIME COMPLETED:
04:04 PM
ALLEGATION(S):
1
2
3
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5
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9
Staff are impaired from drinking alcohol on the job.
Staff stole resident's personal property.
Staff hit the resident.
Staff do not keep resident information private.
INVESTIGATION FINDINGS:
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13
On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose of concluding and delivering findings to address the allegations listed above. The 10 day visit complaint investigation was conducted on 10/19/2021. A follow up complaint investigation visit was conducted on 09/07/2022 to conduct interviews with interviewees, review and collect resident records but not limited to physician reports, needs and services plans and identification forms. On today's date, LPA Quiroz arrived to the facility and was greeted, COVID-19 screened and met with Caregiver Kristine Guevarra. Caregiver Kristine Guevarra called Licensee/Administrator Uldarico Almiranez via facility telephone on speaker phone. LPA Quiroz discussed purpose of today's call with L/AD Almiranez via telephone.
During the course of the investigation the following was reviewed for Resident 1 (R1), Resident 2, Resident 3, Resident 4: Physician reports, identification forms and needs and services plans. Nine of Nine interviewees interviewed did not corroborated with 4 of 4 allegations listed above. CONTINUED ON NEXT PAGE...

***THIS IS AN AMENDED REPORT***
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023
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-20211012143927
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: SAINT BENEDICT CARE LLC
FACILITY NUMBER: 306005478
VISIT DATE: 01/09/2023
NARRATIVE
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CONTINUED...Regarding the allegation Staff are impaired from drinking alcohol on the job, LPA Quiroz conducted multiple interviews with residents and staff. Interviews with nine out of nine interviewees reported denying ever witnessing staff drinking alcohol on the job. Seven of the individuals interviewed reported Resident 1 has stated they are going to get staff in trouble and would report things that are untrue. It was reported via interviews that R1 can be paranoid, does not follow rules, and tends to forget things and get confused. Four of nine interviewees reported R1 will collect alcoholic beverage bottles and place them in front of staff and take pictures in an attempt to say they are drinking on the job. Photographs and videos of staff with alcoholic beverage bottles placed in front of them were observed, however, staff do not appear to drink said beverages at any time nor do they appear inebriated.
Regarding the allegation Staff stole resident’s personal property, It was reported via interviews that R1 can be paranoid, does not follow rules, and tends to forget things and get confused. Interview conducted with R1 confirmed that R1 had initially believed their cell phone to be stolen, however, the phone was later found in R1’s own room by R1. Interviews with three of four residents confirm they have never had issues with items being stolen.
Regarding the allegation Staff hit the resident, nine of nine interviews with staff and residents reported staff are kind and nice and do not mistreat residents. During LPA’s visits on 10/19/21, 9/07/22 and 1/09/23 LPA Quiroz did not observe any residents present in distress or disclosing any injuries. LPA Quiroz reviewed staff trainings, which confirmed staff have required Suspected Abuse training.
Regarding the allegation Staff do not keep resident information private, nine of nine interviews conducted with staff, residents and other witnesses revealed that staff do not reveal private information about other residents to unauthorized individuals. However, when staff speak with medical professionals, staff reported speaking to them in the facility Kitchen designated Office area to be able to continue to supervise Resident 5 who requires constant supervision while enjoying activity of their choice. During initial encounter with R1, R1 disclosed personal medical condition to LPA Quiroz without inquiring. One interviewee reported that knowing R1’s condition and reported R1 had disclosed it to them personally.
Based on the evidence gathered from interviews and a review of pertinent documentation, the allegations: "Staff are impaired from drinking alcohol on the job," "Staff stole resident's personal property,"
"Staff hit the resident," and "Staff do not keep resident information private" are deemed Unfounded, meaning that the allegations were false, could not have happened ad/or are without a reasonable basis; Therefore complaint allegations are dismissed. An exit interview was conducted with Licensee/Administrator Uldarico Almiranez via telephone, and a copy of this report along with LIC 811- Confidential Names list were provided to Facility at exit.***THIS IS AN AMENDED REPORT***
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2