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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005599
Report Date: 08/01/2023
Date Signed: 08/01/2023 02:47:31 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
10/16/2020 and conducted by Evaluator Rosie Quiroz
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20201016145443
FACILITY NAME:A1 ELDER CAREFACILITY NUMBER:
306005599
ADMINISTRATOR:SHAH, BINDIFACILITY TYPE:
740
ADDRESS:2538 E LARKSTONE DRIVE #ATELEPHONE:
(714) 202-5403
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:6CENSUS: 6DATE:
08/01/2023
UNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Bindi Shah, AdministratorTIME COMPLETED:
11:24 AM
ALLEGATION(S):
1
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9
-Resident was forced to leave the facility
INVESTIGATION FINDINGS:
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13
 On today's date, Licensing Program Analyst (LPA) Rosie Quiroz made an unannounced visit for the purpose to deliver findings for complaint allegation listed above. LPA Quiroz was greeted and met with Administrator (AD) Bindi Shah and discussed purpose of today's visit.
On 10/19/2020, LPA Quiroz conducted 10 day visit virtually due to COVID-19 precautionary measures.
Regarding the allegation "Resident was forced to leave the facility," the investigation revealed
Resident 1 (R1) was admitted to the facility on 9/26/2020 and voluntarily moved out of the facility on 10/18/2020 to be closer to their family and in an envioronment to better meet his cooking preference needs.
Interviews conducted with six of seven interviewees concluded (R1) refused to eat food provided by the facility and that (R1) preferred to cook his own meals consisting of Indian food with strong spices in his bedrom area. Five of seven interviewees indicated (R1) requested to have an instapot and cooking devices in their bedroom area to cook at their own leisure.
CONTINUED...
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
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-20201016145443
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: A1 ELDER CARE
FACILITY NUMBER: 306005599
VISIT DATE: 08/01/2023
NARRATIVE
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CONTINUED....Five of seven interviewees indicated "The smell was very strong and (R1) would cook late at night in facility kitchen and we started getting complaints from other residents residing in the facility."
Therefore based on the preponderance of evidence through interviews and observations conducted by LPA Quiroz, the allegation that the "Resident was forced to leave the facility" is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint.

An exit interview was conducted with Administrator Bindi Shah via telephone and Caregiver Gloria Sandoval in person, and a copy of this report and LIC 811- Confidential Names were provided at exit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2