306006311-9-28-2023-22-AS-AORZ-CWNT9G-20231016143155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006311
Report Date: 09/28/2023
Date Signed: 09/28/2023 09:24:51 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
09/18/2023 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20230918104141

FACILITY NAME:	KAYLA'S BOARD & CARE		FACILITY NUMBER:	306006311
ADMINISTRATOR:	RINGOR, ELVIE B.		FACILITY TYPE:	740
ADDRESS:	6593 E CALLE DEL NORTE		TELEPHONE:	(714) 600-7269
CITY:	ANAHEIM HILLS	STATE: CA	ZIP CODE:	92807
CAPACITY:	6	CENSUS: 4	DATE:	09/28/2023
		UNANNOUNCED	TIME BEGAN:	08:42 AM
MET WITH:	Elvie and Rommel Ringor		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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Staff are utilizing garage as staff's living quarters

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. 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 and interviewed Administrator and House Manager. Regarding the allegation that staff are utilizing garage as staff's living quarters, the investigation revealed the following: LPA observed two chairs and a television in the garage. House Manager/ Licensee indicates that only House Manager utilizes the area for television watching in evenings. Both indicate no staff or residents utilize the area. Code Enforcement inspected the area on 09/22/2023 and found no violations. Telephone call to Anaheim Fire confirmed the television and chairs are permissible under fire clearance granted 05/09/2023. Community Care licensing regulations state, "No room commonly used for other purposes shall be used as a sleeping room for any resident." LPA observed no evidence of the space being used as a sleeping room for resident or staff. Therefore the allegation is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to facility representative.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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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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
09/18/2023 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20230918104141

FACILITY NAME:	KAYLA'S BOARD & CARE		FACILITY NUMBER:	306006311
ADMINISTRATOR:	RINGOR, ELVIE B.		FACILITY TYPE:	740
ADDRESS:	6593 E CALLE DEL NORTE		TELEPHONE:	(714) 600-7269
CITY:	ANAHEIM HILLS	STATE: CA	ZIP CODE:	92807
CAPACITY:	6	CENSUS: 4	DATE:	09/28/2023
		UNANNOUNCED	TIME BEGAN:	08:42 AM
MET WITH:	Elvie and Rommel Ringor		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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9

Uncleared individual on the premises of facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. 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 and interviewed Administrator and House Manager. Regarding the allegation that uncleared individual on the premises of facility, the investigation revealed the following: LPA reviewed cleared individuals working at the facility on the Guardian System. Staff 1(S1) is not on the facility roster nor is LPA able locate the individual in the Guardian System as fingerprint cleared. The preponderance of evidence standard has been met, therefore the above allegation is 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 representative along with appeal rights.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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-20230918104141

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: KAYLA'S BOARD & CARE	FACILITY NUMBER: 306006311
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/28/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/26/2023 Section Cited CCR 87355(e)(1)	1 2 3 4 5 6 7	All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing.. in a licensed facility: Obtain a California clearance... as required by the Department. This req is not being met as evidenced by:	1 2 3 4 5 6 7	Licensee to obtain a criminal record clearance for S1 and forward proof to LPA by POC due date.
	8 9 10 11 12 13 14	Based on record review, Licensee failed to ensure S1 has a criminal background clearance. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

LIC9099 (FAS) - (06/04)

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