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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006311
Report Date: 09/17/2024
Date Signed: 09/17/2024 10:42:46 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
09/10/2024 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20240910082518
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: 4DATE:
09/17/2024
UNANNOUNCEDTIME BEGAN:
08:25 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 visit, 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: Three out of three staff deny any uncleared individuals at the facility. Facility Administrator indicates many family members as well as therapists visit on the weekend. Interview with two out of two residents and witness confirms only family members and medical personnel are at the facility on the weekend. Administrator indicated formal visiting hours are 9AM to 8PM but the facility is flexible with visitation. LPA verified all staff on the LIC 500 are background cleared and associated to the facility. Based on interviews conducted, LPA is unable to corroborate the allegation. Therefore, 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 Administrator..
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
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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