306006342-5-6-2025-22-AS-LMOA-DH75MR-20250530200507

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006342
Report Date: 05/06/2025
Date Signed: 05/06/2025 04:35:25 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
04/29/2025 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250429145933

FACILITY NAME:	MARIGOLD BOARD AND CARE		FACILITY NUMBER:	306006342
ADMINISTRATOR:	TRANAE QUATICE GATLIN		FACILITY TYPE:	740
ADDRESS:	8601 SAN ROMOLO WAY		TELEPHONE:	(661) 236-6787
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	6	CENSUS: 5	DATE:	05/06/2025
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Tranae Gatlin		TIME COMPLETED:	03:44 PM

ALLEGATION(S):

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Facility does not provide enough food
Facility staff not providing resident's with prescribed medication
Facility staff are placing restrictions on residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint received April 29, 2025. LPA Haley was greeted by staff and explained the reason for the visit upon entry. During the visit interviews were conducted with staff, residents, observations were made, and photos were taken.

Regarding the allegation: Facility does not provide enough food
During the investigation, 4 of 5 residents’ interview during the investigation denied the allegation. One of the residents stated they cook two times a week and whatever they need, facility staff will buy. One of the residents did not have a problem with the amount of food served, but stated the food is not always served warm. One of the residents interviewed stated they received enough food, but the resident stated they’re always hungry. The resident has talked to their physician about their hunger issue which is related to the resident’s diagnosis.
Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

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-20250429145933

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: MARIGOLD BOARD AND CARE	FACILITY NUMBER: 306006342
	VISIT DATE: 05/06/2025

NARRATIVE

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The one resident who made a statement about the amount of food being served, later on during the interview the same resident said they’ve lost weight because they’ve chosen to eat less and drink less water.

Regarding the allegation: Facility staff are not providing resident's with prescribed medication

During the visit, 5 of 5 residents stated they received their medications. One of the residents receives their blood pressure medication after they return from dialysis because if they take it before they do to dialysis their blood pressure would drop too low, so the medication is administered when the resident returns home. One of the residents say they don’t take too much medication staff always prepares their medications for them, so the resident can take them on time. During a review of resident medication administration records (MAR) for 3 of 6 residents, medications were administered as prescribed, according to the MAR.

Regarding the allegation: Facility staff are placing restrictions on residents

During the visit, 0 of 5 residents were able to provide any evidence or information to support the allegation. According to one of the residents they can’t go anywhere alone. Staff also denied any restriction have been placed on any of the resident other than normal house rules. One of the staff explained one of the residents was recently married and their partner comes to the facility a lot, so staff had to speak to the resident about privacy of their roommate because the recently married resident has a roommate. Staff explained to the newly married resident they have to make sure their partner is not violating the privacy of the roommate.

Based on the information gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there’s not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations above are deemed Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025

LIC9099 (FAS) - (06/04)

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