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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005478
Report Date: 02/01/2023
Date Signed: 03/02/2023 05:17:16 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
08/29/2022 and conducted by Evaluator Rosie Quiroz
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220829124546
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:
02/01/2023
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Kristine Guevarra, Caregiver and Uldarico "Rico" Almiranez, Licensee/AdministratorTIME COMPLETED:
11:21 AM
ALLEGATION(S):
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-Resident is being financially abused while in care
INVESTIGATION FINDINGS:
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 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 allegation listed above. The 10 day visit complaint investigation was conducted on 09/07/2022. During the 10 day inspection visit, LPA Quiroz conducted facility inspection tour,conducted interviews with interviewees consisting of staff, residents and other witnesses. LPA Quiroz requested and reviewed the following records but not limited to: Needs and Services Plans, Physician Reports, Admission Agreements 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 (L/AD) Uldarico Almiranez via telephone and LPA Quiroz discussed purpose of today's visit via telephone.
During the course of the investigation, LPA Quiroz conducted multiple interviews consisting of residents staff and other witnesses. Interviews conducted with three out of nine interviewees reported via interviews that R1 can be paranoid, does not follow rules, and tends to forget things and get confused. CONTINUED...
***THIS IS AN AMENDED REPORT***
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
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-20220829124546
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: 02/01/2023
NARRATIVE
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CONTINUED...
Three residents interviewees reported not being financially abused at facility. Nine of nine interviewees did not corroborate with the allegation "Resident is being financially abused while in care."
During the course of the investigation, LPA Quiroz reviewed video evidence. During video evidence review, LPA Quiroz was able to listen to conversation between Resident 1 (R1) and (L/AD) Almiranez where (L/AD) Almiranez is heard requesting for R1 to sign the admission agreement; (R1) can be heard indicating that he was requested to sign the admission agreement and not signing his finances over to the facility. However, the document being signed is not visible as video recording reflects recording of a wall, R1's face and pictures displayed on the wall. Interview conducted with R1 on 9/7/2022 revealed confirmation that R1 signed the admission agreement and hand written document indicating R1 is handing over disability benefits to facility effective 10/2021.

Based on the evidence gathered from interviews conducted with nine interviewees, video evidence and a review of pertinent documentation, the allegations: "Resident is being financially abused while in care” is deemed Unfounded, meaning that the allegation was false, could not have happened or is without a reasonable basis; Therefore complaint allegations is dismissed.

An exit interview was conducted with Licensee/Administrator Uldarico Almiranez, 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: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2