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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005868
Report Date: 03/19/2024
Date Signed: 03/19/2024 04:14:59 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
03/11/2024 and conducted by Evaluator Celine DePerio
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240311133610
FACILITY NAME:ELEONOR'S PLACE 1FACILITY NUMBER:
306005868
ADMINISTRATOR:AVENDANO, DARYLLFACILITY TYPE:
740
ADDRESS:24152 JAGGER STREETTELEPHONE:
(949) 547-5377
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 6DATE:
03/19/2024
UNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Facility Administrator - Mark Cruz TIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Facility is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced 10-day visit to the facility for the complaint and to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted, and granted entry by facility administrator (AD) Mark Cruz.

During the investigation, LPA De Perio toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed.

It was alleged that the facility is in disrepair. 4 out of 4 resident interviews conducted did not corroborate with the allegation by stating that there are no health and safety concerns, nor ever observed the facility being in disrepair. 2 out of the 2 interviews conducted with staff stated that the cameras placed in the common areas of the facility, are not operational, were placed prior to selling the business in 2020, and that no one has access to any footage because the cameras are not functional. LPA De Perio also observed that there were no cameras located in the residents rooms.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
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-20240311133610
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ELEONOR'S PLACE 1
FACILITY NUMBER: 306005868
VISIT DATE: 03/19/2024
NARRATIVE
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During the physical plant of the facility, LPA De Perio observed that the kitchen stove was clean, observed no rust, and that all five burners are functional. LPA De Perio observed that the kitchen counter is patched with a pasted seal in the tiles that were chipped and observed no sharp or broken edges.

LPA De Perio also observed that there is a hole in the ceiling, but is covered with a dry wall patch and is inaccessible to residents. 2 out of the 2 interviews conducted with staff also stated that prior to making any repairs throughout the facility, it needs to be approved by the landlord. Per documentation review, facility staff contacted the landlord on 12/11/23 inquiring if the hole in the ceiling (referred to as the "sky dome") could be fixed, however, received no response as of 3/19/24.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted with AD Cruz.

A copy of this report was provided and explained.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2