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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005722
Report Date: 08/15/2023
Date Signed: 08/15/2023 02:30:54 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
08/08/2023 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230808134542
FACILITY NAME:IRIS GUEST HOMEFACILITY NUMBER:
306005722
ADMINISTRATOR:DAO, BREVETFACILITY TYPE:
740
ADDRESS:2702 N BERKELY STTELEPHONE:
(714) 602-7911
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY:6CENSUS: 4DATE:
08/15/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ben Briones- CaregiverTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility denied visitors
INVESTIGATION FINDINGS:
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On this day Licensing Program Analysts (LPAs) Andrea Mendivil and Rosie Quiroz made an unannounced visit to conduct a complaint investigation. LPA Mendivil and LPA Quiroz were greeted granted entry into the facility by caregiver Ben Briones and explained the reason for the visit. Administrator Brevet Dao was available by phone.

The department received a complaint on 08/08/2023. During the course of the investigation LPA Mendivil inteviewed staff and obtained copies of documents such as admission agreement. Regarding the allegation faciltiy denied visitors, the investigation revealed the following:

Based on review of facility's admission agreement visitation hours are from 9am-7pm and admission agreement states "should other visiting times be needed, please contact the facility in advance to make arrangements".
CONT on LIC 9099-C dated 08/15/2023.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
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-20230808134542
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: IRIS GUEST HOME
FACILITY NUMBER: 306005722
VISIT DATE: 08/15/2023
NARRATIVE
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 Based on interview with facility staff there was not been a time they have denied access to visitations. It was reported by witnesses that the facility did not allow visitations at 7:45pm and facility was called and no one responded to the door bell or phone. Interview with witness stated they did not call prior to 7:45pm to arrange a late visitation. Interviews with staff indicate they do not remember an instance when they did not answer the phone or the door.

Therefore based on a preponderance of evidence through interviews and records reviewed the allegation facility denied visitors is determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. This agency has investigated this complaint.

No deficiencies cited.

An exit interview was conducted and a copy of this report this report was left at the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2