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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005633
Report Date: 08/22/2024
Date Signed: 08/22/2024 03:40:12 PM

Unsubstantiated


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
08/13/2024 and conducted by Evaluator Claudia Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240813083750
FACILITY NAME:MARYKNOLL SENIOR CAREFACILITY NUMBER:
306005633
ADMINISTRATOR:UMALI, FRANCES AMANDAFACILITY TYPE:
740
ADDRESS:531 WHITTEN WAYTELEPHONE:
(805) 836-1556
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 4DATE:
08/22/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Frances Amanda UmaliTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not prevent resident from exposing herself while in the presence of other residents in care
Staff did not prevent resident from having physical altercations with other residents in care
INVESTIGATION FINDINGS:
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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analysts (LPAs) Claudia Gutierrez and Samer Haddadin regarding the allegations mentioned above. LPAs met with Administrator (AD) Frances Amanda Umali and explained the purpose of the inspection.

Interviews were conducted with three facility staff, and three residents, regarding the allegation staff did not prevent resident from exposing herself while in the presence of other residents in care. Three of three staff interviewed denied any resident exposes themselves in the presence of other residents. Three of three residents interviewed denied exposing themselves to other residents and denied witnessing other residents exposing themselves.

Interviews were conducted with three facility staff, and three residents, regarding allegation staff did not prevent resident from having physical altercations with other residents in care. (Cont. LIC9099-C)
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
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-20240813083750
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: MARYKNOLL SENIOR CARE
FACILITY NUMBER: 306005633
VISIT DATE: 08/22/2024
NARRATIVE
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Three of three staff interviewed denied any facility residents having a physical altercation. Three of three residents denied personally having physical altercations and denied witnessing other residents having a physical altercation.

Due to allegations being uncorroborated during interviews conducted, LPA is unable to determine if staff did not prevent resident from exposing herself while in the presence of other residents in care or if staff did not prevent resident from having physical altercations with other residents in care. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated.

An exit interview was conducted and copy of this report was provided at the end of the inspection.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2