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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006452
Report Date: 09/09/2024
Date Signed: 04/21/2025 03:58:10 PM

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
06/26/2024 and conducted by Evaluator Dwayne L Mason
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240626135527
FACILITY NAME:ANAHEIM PALACEFACILITY NUMBER:
306006452
ADMINISTRATOR:CHON, CHRISTINE MFACILITY TYPE:
740
ADDRESS:525 W. LA PALMA AVETELEPHONE:
(714) 459-3353
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:199CENSUS: 196DATE:
09/09/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Susan Lee - Executive DirectorTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Staff refused to assist resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegation. LPA arrive at facility was greeted and granted entry by staff. LPA met with Susan Lee, Executive Director and explained the nature of the visit.

Findings are based upon this investigation which included resident file review, tour of the physical plant of the facility and interviews conducted.

It is alleged staff refused to assist resident, details of the complaint states two staff members. In review of staff schedule for caregiver it does not reflect any caregivers with names mentioned in the complaint detail submitted. Upon review it was indicated that staff mentioned in complaint details were a facility nurse and the

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

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

DATE: 09/09/2024
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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Control Number 22-AS-20240626135527
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ANAHEIM PALACE
FACILITY NUMBER: 306006452
VISIT DATE: 09/09/2024
NARRATIVE
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resident care coordinator which are no longer employed at the facility. Interview with 8 of 8 residents stated that they get the assistance that they need, and they have no issues getting help. Interview with a witness stated that resident gets the help they need and that they are notified immediately upon any issues that resident may have. Interview with 4 of 4 facility staff stated that residents request help and caregivers/staff provide the care requested. Staff stated that they have not received a complaint or concern from any residents indicating they didn't get the help they requested. Staff stated that resident (R1) gets the help they need, but no matter what R1 always complains for one reason or another. R1 tends to get agitated a lot if things aren't done how they want them to be done or at the time frame they want them to be done. Staff stated that maybe residents diagnosis plays a role in their behavior, but none the less all residents get the assistance that they need.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted with facility representative and a copy of this LIC9099 report was left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

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

DATE: 09/09/2024
LIC9099 (FAS) - (06/04)
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