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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600104
Report Date: 01/08/2026
Date Signed: 01/08/2026 02:20:57 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/30/2025 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251230152528
FACILITY NAME:MIRADA MANORFACILITY NUMBER:
198600104
ADMINISTRATOR:ROBERT TALENSFACILITY TYPE:
735
ADDRESS:14926 COSTA MESA DRTELEPHONE:
(714) 994-4749
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:6CENSUS: 2DATE:
01/08/2026
UNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:Administrator Robert TalensTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not administer medication to resident according to physician's intructions.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted an initial complaint visit to investigate the above allegations. LPA met with Assistant Administrator Eloisa Talens and discussed the purpose of today's visit. Administrator Robert Talens arrived shortly.

During this visit, LPA obtained a copy of the staff and client rosters,and copy of Mar for C1.LPA also reviewed two (2) client’s medication, and conducted a tour. LPA reviewed the Corrective Action Plan (CAP) addressing the above allegations issued by Eastern Los Angeles Regional Center dated 12/18/2025 with Robert Talens. Per Administrator Robert Talens, he agrees with the CAP findings and will be complying with the CAP.

Refer to LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 28-AS-20251230152528
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: MIRADA MANOR
FACILITY NUMBER: 198600104
VISIT DATE: 01/08/2026
NARRATIVE
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Allegation: Staff did not administer medication to residents according to physician's instructions. It is alleged that a medication error occurred for Client #1 (C-1) on 11/25/2025. Per issued Corrective Action Plan (CAP), for C-1, BD medication Risperidone 2mg was administered in the morning instead of the prescribed evening (PM) dose. LPA confirmed above information with Administrator Robert Talens. Per Administrator, he agrees with the CAP findings and will be complying with the CAP. Per CAP report and Administrator Robert Talons agreement, this corroborates this allegation.

Based on interviews conducted and document review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Deficiency is being cited according to California Code of Regulations, Title 22. Refer to LIC 9099D.

Exit interview conducted, appeal rights and this report was provided to Administrator.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20251230152528
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MIRADA MANOR
FACILITY NUMBER: 198600104
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2026
Section Cited
CCR
80075.(b)
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80075 Health Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

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Administrator to conduct a staff training on medication administration (including documentation) and provide proof of training to LPA by POC due date.
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Based on record review and interviews conducted, the findings indicate that staff administered C1’s BD medication risperidone 2 MG in the morning instead of prescribed evening (PM) dose. This posed a potential health, safety, and personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/30/2025 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251230152528

FACILITY NAME:MIRADA MANORFACILITY NUMBER:
198600104
ADMINISTRATOR:ROBERT TALENSFACILITY TYPE:
735
ADDRESS:14926 COSTA MESA DRTELEPHONE:
(714) 994-4749
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:6CENSUS: 2DATE:
01/08/2026
UNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:Administrator Robert TalensTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
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9
Staff did not follow reporting requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted an initial complaint visit to investigate the above allegations. LPA met with Assistant Administrator Eloisa Talens and discussed the purpose of today's visit. Administrator Robert Talens arrived shortly.

During this visit, LPA obtained a copy of the staff and client rosters, copy of Mar for C1, and email to LPA Zaragoza for special incident reported (SIR) with the date of 12/01/2025.LPA also reviewed two (2) client’s medications, and conducted a tour. LPA reviewed the Corrective Action Plan (CAP) addressing the above allegations issued by Eastern Los Angeles Regional Center dated 12/18/2025 with Robert Talens.

Refer to LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20251230152528
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: MIRADA MANOR
FACILITY NUMBER: 198600104
VISIT DATE: 01/08/2026
NARRATIVE
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Allegation: Staff did not follow reporting requirements. It is alleged that staff did not submit a special incident report (SIR) to licensing following a medication error dated 11/25/2025. Per issued Corrective Action Plan (CAP), Administrator did not report medication error. LPA was able to obtain email with SIR sent to East Los Angeles Regional Center along with Community Care Licensing with the above incident of the medication error that occurred. Additionally, Administrator stated the day the error occurred was the day of audit therefore no SIR was made until he was aware of the error. Per Administrator, he disagrees with the CAP findings.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was provided.

Exit interview conducted, appeal rights and this report was provided to Administrator.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5