Complaint Investigation Report

306006386-4-1-2025-22-AS-AORZ-DG6LCY-20250428083905

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

ORANGE COUNTY RO , 770 THE CITY DR., SUITE 7100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

03/24/2025 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20250324082636

Tricia Pedroza, Licensee and Ephantus Warui, Administrator

Staff do not ensure residents call button is in reach

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit at 8am to investigate a complaint received in our Regional Office on March 24, 2025. LPA met with Tricia Pedroza, Licensee and Ephantus Warui, Administrator and explained the purpose of the visit.

LPA requested the following documents: Resident roster, Personnel Report,and Unusual Incident Reports. LPA interviewed three of three residents regarding care provided and four of four staff members regarding care given. LPA toured the facility and entered five of five resident rooms and discovered one room did not have a working call button and resident was not able to reach it. At the end of the visit, call button was repaired and tested by LPA and resident's bed was moved to reach the call button on the wall.

Based on LPA observations and interviews, the following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Tricia Pedroza, Licensee and a copy of this report was given to the facility along with a copy of the LIC 9099-D and Appeal Rights.