<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006153
Report Date: 08/10/2023
Date Signed: 08/10/2023 03:29:29 PM

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
08/03/2023 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230803092428
FACILITY NAME:CARE JANELLAFACILITY NUMBER:
306006153
ADMINISTRATOR:CALANGI, KARMIANFACILITY TYPE:
740
ADDRESS:17072 SAGA DRIVETELEPHONE:
(714) 683-4617
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:6CENSUS: 5DATE:
08/10/2023
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Leonora Amorsolo - AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident developed pressure injuries while in care due to neglect.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint received against this facility on August 3, 2023. LPA Haley was greeted by staff and explained the reason for the visit. Administrator (AD) Leonora Amorsolo arrived a short time later.
During the visit, LPA Haley conducted 8 interviews and collected relevant documentation during the visit.

Regarding the allegation: Resident developed pressure injuries while in care due to neglect.

5 of 8 witnessed denied the allegation above. Interviews revealed residents are rotated every two hours by caregivers on duty. Regarding Resident 1 (R1), it was discovered, R1 receives Palliative care and is seen by a nurse on a weekly basis. R1 was sent to the hospital due to general weakness July 26, 2023 and returned to the facility the same day. After review of the After Visit Summary from Kaiser dated July 26, 2023, there was not mention of a pressure injury.
Continued on LIC 9099C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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-20230803092428
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: CARE JANELLA
FACILITY NUMBER: 306006153
VISIT DATE: 08/10/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During interviews it was discovered redness was observed on the buttocks area of R1 due to shingles, diarrhea, and R1 being difficult with caregivers and not allowing them to provide the proper care. R1 was prescribed Lidocaine-Prilocaine to apply to the affected areas 2 times a day as needed. During the visit LPA Haley observed the visible portions of R1's back with assistance from 2 caregivers and no pressure wound was observed.

Based on the information gathered during the investigation through interviews, record review, and observation, the following allegation: Resident developed pressure injuries while in care due to neglect, is deemed Unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2