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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006204
Report Date: 08/21/2023
Date Signed: 08/21/2023 02:53:09 PM

Substantiated


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
07/31/2023 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20230731155923
FACILITY NAME:WILLOW VIEW GARDENS MEMORY CARE & ASSISTED LIVINGFACILITY NUMBER:
306006204
ADMINISTRATOR:ESPINAL, ALMAFACILITY TYPE:
740
ADDRESS:2025 N BUSH STTELEPHONE:
(714) 541-3357
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:130CENSUS: 66DATE:
08/21/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Alma EspinalTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Facility does not have adequate staffing to meet resident care needs
Staff do not attend to residents in a timely manner
Residents are not provided with activities
Residents are not provided adequate shower assistance
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility, interviewed staff, residents and witnesses as well as reviewed and obtained pertinent documentation such as staff schedule. Regarding the allegations that facility does not have adequate staffing to meet resident care needs, staff do not attend to residents in a timely manner, residents are not provided with activities and residents are not provided adequate shower assistance, the investigation revealed the following: Eight out of nine residents interviewed indicate a staffing shortage and state caregivers are working as dining room servers. Staff and Administrator confirm caregivers are filling in as servers and activity coordinators. Staff indicate working two per shift with a med tech. Facility has no dedicated dining room servers or activity coordinator at time of complaint. During the visit on 08/08/2023, LPA activated the pull cord in room #117's restroom and no staff responded within a twenty minute time frame. Administrator indicated CONTINUED ON LIC 9099C DATED 08/21/2023
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
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 6
Control Number 22-AS-20230731155923
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: WILLOW VIEW GARDENS MEMORY CARE & ASSISTED LIVING
FACILITY NUMBER: 306006204
VISIT DATE: 08/21/2023
NARRATIVE
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the notification was not received timely for a caregiver to respond. Two residents who utilize the pull cord confirmed up to an hour delay in response when activating the pull cord. Nine out of nine residents interviewed confirmed a lack of activities in the facility as well as no outings in the community. LPA observed residents conducting their own game of bingo without any assistance from staff. Staff interviewed confirmed no activities in the morning, only in the afternoon which consists of bingo. Three out of four residents who receive shower assistance stated missing showers and Administrator indicated an issue with having enough female caregivers to shower female residents. Facility provided a shower schedule to LPA and two residents who receive shower assistance are not on the schedule. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided to facility administrator via email along with appeal rights.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 22-AS-20230731155923
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: WILLOW VIEW GARDENS MEMORY CARE & ASSISTED LIVING
FACILITY NUMBER: 306006204
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2023
Section Cited
CCR
87468.2(a)(4)
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... residential care facilities for the elderly shall have all of the following personal rights: To care, supervision... are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This req is not being met as evidenced by:
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Licensee to forward a hiring plan to LPA by POC due date as well the staffing agency information.
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Based on interviews conducted, Licensee failed to ensure residents are cared for by sufficient numbers of staff. Staff are performing duties including dining room service and activity coordination. This poses an immediate health and safety risk to residents in care.
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Type A
08/22/2023
Section Cited
CCR
87464(f)(1)
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Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code
section 1569.2(c). This requirement is not being met as evidenced by:
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Licensee has had a repair company come into facility to repair call lights. Licensee to forward proof of repair to LPA by POC due date.
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Based on observation and interview, Licensee failed to ensure care is being provided to residents in care. Facility staff are not responding to resident pendant pulls. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 22-AS-20230731155923
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: WILLOW VIEW GARDENS MEMORY CARE & ASSISTED LIVING
FACILITY NUMBER: 306006204
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2023
Section Cited
CCR
87468.2(a)(23)
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.. residents in.. residential care facilities for the elderly shall have all of the following personal rights: to be encouraged to develop and maintain their fullest potential for independent living through participation in activities..This req is not being met as evidenced by:.
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Please develop and maintain a working activity schedule and forward proof to LPA by POC due date.
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Based on observation and interviews, Licensee failed to ensure activities are being provided to residents. Although facility has an activity calendar, all residents interviewed confirm a lack of activities. LPA observed only bingo in the afternoon. This poses a potential personal rights risk to residents in care.
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Type B
09/04/2023
Section Cited
CCR
87464(f)(4)
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(f) Basic services shall at a minimum include: Personal assistance and care as needed by .. with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications...This req is not being met as evidenced by:
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Licensee to forward a plan to ensure residents are getting showered by POC due date.
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Based on record review and interviews conducted, Licensee failed to ensure residents are being showered as required. Residents state not being showered and shower schedule confirms this. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
07/31/2023 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20230731155923

FACILITY NAME:WILLOW VIEW GARDENS MEMORY CARE & ASSISTED LIVINGFACILITY NUMBER:
306006204
ADMINISTRATOR:ESPINAL, ALMAFACILITY TYPE:
740
ADDRESS:2025 N BUSH STTELEPHONE:
(714) 541-3357
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:130CENSUS: 66DATE:
08/21/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Alma EspinalTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Elevator is not properly maintained
Facility carpet is not properly cleaned
Staff do not treat residents with dignity and respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility, interviewed staff, residents and witnesses as well as reviewed and obtained pertinent documentation such as carpet cleaning records and elevator maintenance. Regarding the allegations that staff do not treat residents with dignity and respect, facility carpet is not properly cleaned and elevator is not properly maintained, the investigation revealed the following: Two out of nine residents state being talked to in a disrespectful way by management. Residents state being aware of the resident council meetings but state the notifications for the meetings do not seem to be available for all residents. During the investigation, LPA observed carpet in various rooms and throughout the facility. Some carpets appeared to have been newly cleaned. Facility provided proof of carpet cleaning approximately every 5-6 months. Facility provided documentation of correspondance with Kone elevator repair company regarding maintenance. CONTINUED ON LIC 9099C DATED 08/21/2023.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20230731155923
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: WILLOW VIEW GARDENS MEMORY CARE & ASSISTED LIVING
FACILITY NUMBER: 306006204
VISIT DATE: 08/21/2023
NARRATIVE
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Correspondence included a failure to pay notice to facility dated July 7, 2023. Facility subsequently rectified the situation and servicing was done on 08/17/2023. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6