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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005597
Report Date: 02/08/2023
Date Signed: 02/08/2023 10:34:43 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
12/23/2022 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221223145106
FACILITY NAME:COAST SENIOR CARE 3FACILITY NUMBER:
306005597
ADMINISTRATOR:VIANA, KRISTENFACILITY TYPE:
740
ADDRESS:6822 MARILYN DRTELEPHONE:
(714) 470-0194
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 6DATE:
02/08/2023
UNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Caregiver, Renato GaldonesTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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9
Staff does not allow resident to have visitors
Staff behaves inappropriately in front of residents in care
INVESTIGATION FINDINGS:
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On this day Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to deliver findings on complaint investigation. LPA was granted entry by staff. LPA discussed purpose of the visit with Caregiver Renato Galdones.

During the course of this investigation LPA toured facility, conducted interviews with staff, residents and families of residents. Observations of residents in care, staff working, and a review of records was completed. It is alleged that staff does not allow resident to have visitors and staff behaves inappropriately in front of residents in care. Based on information received in interviews the investigation revealed that one out of seven family members interviwed had visitation issues at facility. Interviews conducted with staff revealed that three out of three staff state they have never denied resident’s visitation.

LPA reviewed staff records and observed no disciplinary actions or behaviors in files that indicated inappropriate activity. CONTINUED ON 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
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-20221223145106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: COAST SENIOR CARE 3
FACILITY NUMBER: 306005597
VISIT DATE: 02/08/2023
NARRATIVE
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Per interviews conducted staff 1 (S1) admitted that one time they did slam kitchen cupboards out of frustration and acknowledged it was unprofessional. Two out of three staff and six out of seven family members indicated they have never observed any issues with staff. Residents interviewed also indicated no issues with staff.

Based on conflicting information received from interviews, the lack of information regarding the incidents in question, and the lack of corroborating witness to the incidents, LPA is unable to determine if the alleged violations occurred as reported.

We have found the complaint allegations are 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. This report is being reviewed with Caregiver and a copy of this report along with a LIC 811 confidential name list was left at the facility.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2