300602548-11-19-2025-22-AS-APAO-DNN6BC-20251121193944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300602548
Report Date: 11/19/2025
Date Signed: 11/19/2025 01:44:31 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
08/29/2023 and conducted by Evaluator Celine Rodriguez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230829113742

FACILITY NAME:	KATELLA SENIOR LIVING COMMUNITY		FACILITY NUMBER:	300602548
ADMINISTRATOR:	CHRISTINE GREENWAY		FACILITY TYPE:	740
ADDRESS:	3952 KATELLA AVENUE		TELEPHONE:	(562) 596-2773
CITY:	LOS ALAMITOS	STATE: CA	ZIP CODE:	90720
CAPACITY:	140	CENSUS: 55	DATE:	11/19/2025
		UNANNOUNCED	TIME BEGAN:	07:00 AM
MET WITH:	Operations Manager- Jaleesa Chavez		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not serve residents' meals in a timely manner.
Staff do not distribute residents' medications as prescribed.
Staff do not ensure that a resident's incontinence needs are met.
Staff do not provide residents with laundry service.
Staff do not maintain the facility clean and sanitary at all times.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced continuation visit to the facility for the complaint and to deliver the findings. LPA Rodriguez explained the purpose of today's visit, was greeted by Operations Manager (OM) Jalessa Chavez.

During the investigation, LPA Rodriguez toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed.

It was alleged that staff do not serve residents' meals in a timely manner. 7 out of 7 resident interviews, and 2 out of 2 staff interviews did not corroborate with the allegation. During the tour of the facility, LPA observed that in the memory care unit, breakfast was being served at 7:00AM, and lunch at 11:00AM, of which matched with the posted meal schedule.

Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025

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-20230829113742

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: KATELLA SENIOR LIVING COMMUNITY	FACILITY NUMBER: 300602548
	VISIT DATE: 11/19/2025

NARRATIVE

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On the assisted living area, LPA observed breakfast being served at 7:30AM, and lunch at 11:30AM, of which also matched with the posted meal schedule. Per LIC500, there are a total of 6 dining room staff present, not including caregivers and med-techs, who also assist in serving meals, including tray service.

It was alleged that staff do not distribute residents' medications as prescribed. 7 out of 7 resident interviews, and 2 out of 2 staff interviews did not corroborate with the allegation. Per documentation review, resident 3 (R3) assists spouse/resident 4 (R4) with insulin injections, of which this was approved by R3’s doctor stating that R3 is capable of assisting R4; however, staff will supervise R3 and R4 when the insulin injectable are being administered. In addition to the documentation review, LPA observed that R4 is prescribed two insulin injectables (Lispro for morning and afternoon, and Tresiba for evening), and on 11/12/25, it was reported that R4 was given the morning insulin at night, to which despite R4 not experiencing a reaction, 911 was still contacted for further evaluation.

It was alleged that staff do not ensure that a resident's incontinence needs are met. 7 out of 7 resident interviews, and 2 out of 2 staff interviews did not corroborate with the allegation. During the tour of the facility, LPA observed staff on duty changing a resident, and LPA also observed that facility is equipped with adequate incontinence supplies.

It was alleged staff do not provide residents with laundry service. 7 out of 7 resident interviews, and 2 out of 2 staff interviews did not corroborate with the allegation. During the tour of the facility, LPA observed that laundry was actively being done and that the facility has a schedule of when resident laundry services are conducted. Per documentation review, laundry services are conducted daily with the specified resident rooms. In addition, LPA observed that there are 3 resident rooms that do not obtain laundry service, however it is due to residents opting out of the facility laundry services because the residents family does it, of which this was confirmed via resident admission agreement.

Continued on LIC9099-C...

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20230829113742

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: KATELLA SENIOR LIVING COMMUNITY	FACILITY NUMBER: 300602548
	VISIT DATE: 11/19/2025

NARRATIVE

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It was alleged that staff do not maintain the facility clean and sanitary at all times. 7 out of 7 resident interviews, and 1 out of 1 staff interviews did not corroborate with the allegation. Upon entering the facility, LPA observed staff actively cleaning resident rooms in both the assisted living and memory care areas of the facility. LPA also observed that facility is equipped with adequate amount of cleaning supplies and observed a total of 2 staff members on duty who were cleaning on the assisted living and memory care portion.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegations 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 violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted with OM Chavez.

A copy of this report was explained, and provided.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025

LIC9099 (FAS) - (06/04)

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