306006269-4-11-2025-22-AS-SSAS-DFZ33Q-20250422175353

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006269
Report Date: 04/11/2025
Date Signed: 04/11/2025 01:23:28 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
01/31/2025 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250131113817

FACILITY NAME:	GRANNY'S PLACE #7		FACILITY NUMBER:	306006269
ADMINISTRATOR:	NESBITT, MICHELLE		FACILITY TYPE:	740
ADDRESS:	24332 SPARTAN ST		TELEPHONE:	(949) 533-5938
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 6	DATE:	04/11/2025
		UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Kimberly Arnett, Assistant Administrator Michelle Nesbitt, Administrator Jozef Springer, Executive Director		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Inadequate toileting care provided by facility staff resulted in multiple occurrences of urinary tract infections among residents

Facility staff is not following the Infection Control Plan

Administrator made a false statement about the whereabouts of a former employee

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the three allegations listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator staff Kimberly Arnett, Michelle Nesbitt and Jozef Springer were notified via telephone and arrived later to assist with the visit.

The initial complaint investigation visit was conducted on February 6, 2025. During the visit, LPA reviewed the resident records for four currently admitted residents. Four staff interviews conducted during the visit. Additional records requested to be provided by staff at the earliest convenience. Additional record review and witness interviews were conducted during the investigation.

CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250131113817

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: GRANNY'S PLACE #7	FACILITY NUMBER: 306006269
	VISIT DATE: 04/11/2025

NARRATIVE

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CONTINUED FROM FORM LIC9099
Regarding the allegation that Inadequate toileting care provided by facility staff resulted in multiple occurrences of urinary tract infections among residents, the following has been concluded: Based on staff and witnesses interviews along with review of records provided, the investigation evidenced the presence of a procedure for the reporting of suspected urinary tract infections to the residents' primary care provider accompanied by demonstrated prophylactic measures as well as diagnostic tests being ordered. A review of medical records did not evidence a higher rate of infections that could be attributed to a failure to provide adequate care and supervision

Regarding the allegation that Facility staff is not following the Infection Control Plan, the following has been concluded: Cases of upper respiratory infections occurred in late December/early January and were adequately reported to the Department by the infection prevention staff designated on the Infection Control Plan. Based on records reviewed, preventative treatment was offered to residents. Personal Protective Equipment was confirmed to be available for staff and visitors and mask-wearing was confirmed to be enforced at that time. Follow-up visits did not evidence any ongoing outbreaks at the time.

Regarding the allegation that Administrator made a false statement about the whereabouts of a former employee, the following has been concluded: The termination of staff member S1 was confirmed to have occurred following a verbal altercation with another staff member effective on October 24, 2024. The final pay stub for the staff member was provided to the investigation and the separation was made effective in Guardian.

Based on the investigation conducted, all three allegations are determined to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted and a copy of the report provided to a facility representative.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025

LIC9099 (FAS) - (06/04)

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