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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005845
Report Date: 12/15/2022
Date Signed: 12/15/2022 10:44:53 AM

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
12/08/2022 and conducted by Evaluator Rosie Quiroz
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221208111421
FACILITY NAME:SANTA MARIANA CAREFACILITY NUMBER:
306005845
ADMINISTRATOR:LIMPIADO, GIDEONFACILITY TYPE:
740
ADDRESS:18676 SANTA MARIANATELEPHONE:
(949) 349-8708
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 6DATE:
12/15/2022
UNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Karmian Galang, Administrator Assistant, Friu Sy, Caregiver. TIME COMPLETED:
10:22 AM
ALLEGATION(S):
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-Residents are not afforded comfortable accommodations while in care.
INVESTIGATION FINDINGS:
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 On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted a 10 day visit to address the allegation listed above. LPA Quiroz was greeted, COVID-19 screened and granted entry into the facility by Caregiver 1 (CG1). LPA Quiroz called Administrator Gideon limpiado via telephone and left voicemail providing purpose of today's visit. Facility staff called Karmian Galang via telephone and placed telephone call on speaker phone. Karmian Galang idenfied herself as Administrator Assistant.
During today's vist, LPA Quiroz along with (CG1) conducted a tour of interior and exterior of facility premises and conducted interviews, reviewed documents for Resident 1-Resident 6 including but not limited to: Identification and Emergency Form, Needs and Services Plan, Physician Report and resident roster.
It was alleged that "Residents are not afforded comfortable accommodations while in care." During the course of this investigation, LPA Quiroz reviewed the above mentioned documents requested for review and interviewed interviewees. Seven of seven interviewees did not corroborate with allegation. Seven of seven interviewees indicated "It's comfortable. Not cold in here."
CONTINUED ON NEXT PAGE...

Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
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-20221208111421
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: SANTA MARIANA CARE
FACILITY NUMBER: 306005845
VISIT DATE: 12/15/2022
NARRATIVE
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This agency has found the complaint allegation of "Residents are not afforded comfortable accommodations while in care," is deemed UNFOUNDED; meaning that the allegation was false, could not have happened or is without a reasonable basis. We have therefore dismissed the complaint allegation listed above.

An exit interview was conducted with Facility staff and with Administrator Assistant Karmian Galang via telephone and a copy of this report was provided at exit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2