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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006311
Report Date: 10/19/2023
Date Signed: 10/19/2023 10:48:04 AM

Unsubstantiated


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
10/16/2023 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20231016081604
FACILITY NAME:KAYLA'S BOARD & CAREFACILITY NUMBER:
306006311
ADMINISTRATOR:RINGOR, ELVIE B.FACILITY TYPE:
740
ADDRESS:6593 E CALLE DEL NORTETELEPHONE:
(714) 600-7269
CITY:ANAHEIM HILLSSTATE: CAZIP CODE:
92807
CAPACITY:6CENSUS: 3DATE:
10/19/2023
UNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Elvie RingorTIME COMPLETED:
11:05 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
uncleared individuals staying at the facility over the weekend
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into 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 staff and residents. Regarding the allegation that uncleared individuals staying at the facility over the weekend, the investigation revealed the following: Two out of two residents and four out of four staff deny any overnight guests at the facility. Residents and staff indicate visitors come to the facility on the weekend but do not stay overnight. Facility licensee lives on-site at the facility and indicates periodic guests for a meal but no overnight stays have occurred. Facility schedule indicates Licensee is working on weekends with additional staff on-call. Due to conflicting information, LPA is unable to corroborate the allegation. Based on interviews conducted, the allegation is deemed to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did occur.
An exit interview was conducted and a copy of this report was provided to a facility representative.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
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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