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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006311
Report Date: 11/25/2024
Date Signed: 11/25/2024 09:35:40 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 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
11/15/2024 and conducted by Evaluator Dwayne L Mason
COMPLAINT CONTROL NUMBER: 22-AS-20241115154225
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:
11/25/2024
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Elvie Ringor - AdministratorTIME COMPLETED:
09:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has uncleared individuals staying over night
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Dwayne Mason Jr and Nancy Guillen 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, LPAs toured the facility and interviewed staff and residents. Three out of three staff deny any uncleared individuals at the facility. Facility Administrator (AD) stated a resident recently passed away and family members were visiting more frequently but never stayed the night. Interview with one out of one resident that was able to be interviewed confirms the only people who stay overnight are residents and facility staff. AD indicated formal visiting hours are 10AM to 8PM but can be flexible. AD re-stated that only facility staff and residents stay overnight. LPAs verified all staff on the LIC 500 are background cleared and associated to the facility. Based on interviews conducted and records reviewed, LPAs are 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. Exit interview was conducted and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
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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