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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300600977
Report Date: 05/22/2025
Date Signed: 05/22/2025 11:46:37 AM

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
02/18/2025 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20250218143417
FACILITY NAME:TOWN & COUNTRYFACILITY NUMBER:
300600977
ADMINISTRATOR:SARA MODUGNOFACILITY TYPE:
741
ADDRESS:555 E. MEMORY LANETELEPHONE:
(714) 547-7581
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:328CENSUS: 218DATE:
05/22/2025
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Sara ModugnoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not ensure the facility was free of pests.
INVESTIGATION FINDINGS:
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On today's date, Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility. The purpose of the visit was to deliver findings regarding allegations. LPA Haddadin was greeted by staff and granted entry after stating the visit's purpose.
During the investigation, LPA Haddadin toured the facility, interviewed staff members and residents, and reviewed facility records.
Investigation Findings
Regarding the allegation that "staff did not ensure the facility was free of pests," LPA Haddadin, accompanied by the Administrator (AD), inspected both buildings of the facility. This inspection included the kitchen area, common areas, and six bedrooms in each building. No evidence of pests was found during the inspection. (CONTINUE ***9099C)


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
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 2
Control Number 22-AS-20250218143417
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: TOWN & COUNTRY
FACILITY NUMBER: 300600977
VISIT DATE: 05/22/2025
NARRATIVE
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Interviews and Record Review
LPA Haddadin interviewed three residents, all of whom denied the allegations. Additionally, three staff members were interviewed, and all denied seeing any pests. A review of facility records indicated that the facility undergoes monthly pest and rodent inspections by a third-party service provider. Service dates noted in the records were February 6, 2025; March 5, 2025; April 2, 2025; and May 5, 2025.
Conclusion
Based on the preponderance of evidence gathered through multiple interviews and a review of records, the allegation that "staff did not ensure the facility was free of pests" was found to be UNSUBSTANTIATED. This determination signifies that while the alleged incidents may have occurred or the concerns might be valid, there was insufficient evidence to prove that the alleged violation took place.
No deficiencies were cited during this visit. An exit interview was conducted with the Administrator, and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2