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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005633
Report Date: 03/26/2025
Date Signed: 03/26/2025 11:25:22 AM

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
03/24/2025 and conducted by Evaluator Claudia Gutierrez
COMPLAINT CONTROL NUMBER: 22-AS-20250324161418
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: 5DATE:
03/26/2025
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Frances Amanda UmaliTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Licensee does not ensure facility is adequately staffed to meet resident's needs
INVESTIGATION FINDINGS:
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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegation mentioned above. LPA met with Administrator (AD) Frances Amanda Umali and explained the purpose of the inspection.

It is alleged residents are left alone in the facility. Upon arrival, LPA observed two staff presently working at the facility. LPA obtained and reviewed a copy of Personnel Report (LIC500) and observed there to be staff coverage at all times. Interviews were conducted with four facility staff and four residents. During their interview, four of four residents denied the facility or residents being left alone or unattended, and stated staff is always present to assist. Four of four staff interviewed also denied facility or residents ever being left alone or unattended by staff. Per all four staff, in the event that staff need to run an errand or leave the facility, there is always an additional staff to stay at the facility to supervise and assist residents.
(Cont. LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
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-20250324161418
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: 03/26/2025
NARRATIVE
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After a review of Personnel Report (LIC500) and due to allegation being uncorraborated during interviews conducted, LPA is unable to determine if Licensee does not ensure facility is adequately staffed to meet resident's needs. Although the above allegation may have happened or is 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: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2