300602548-1-17-2026-22-AS-APAO-DQL5AY-20260122184753

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300602548
Report Date: 01/17/2026
Date Signed: 01/17/2026 10:31:04 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
07/06/2021 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20210706095734

FACILITY NAME:	KATELLA SENIOR LIVING COMMUNITY		FACILITY NUMBER:	300602548
ADMINISTRATOR:	CLAIRE CARPENTER		FACILITY TYPE:	740
ADDRESS:	3952 KATELLA AVENUE		TELEPHONE:	(562) 596-2773
CITY:	LOS ALAMITOS	STATE: CA	ZIP CODE:	90720
CAPACITY:	140	CENSUS: 54	DATE:	01/17/2026
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Jalessa Chavez		TIME COMPLETED:	04:13 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Inadequate staffing resulting in resident's toileting needs not being met.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver the findings regarding the above-mentioned allegation. Upon arrival, LPA explained the purpose of the visit and was greeted by Operations Manager (OM) Jalessa Chavez.
As part of the investigation, LPA toured the facility’s physical plant, conducted interviews, and requested copies of pertinent records for review.
It was alleged that “inadequate staffing resulted in residents’ toileting needs not being met”. During the visit, LPA completed a health and safety check and observed four caregivers on duty, including two assigned to the Memory Care Unit and two assigned to Assisted Living. At the time of the visit, the facility had a total of 54 residents in care.
LPA conducted five staff interviews. Five out of five staff denied the allegation and further stated they conduct resident checks every two hours.{***CONTINUE 9099C***}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2026

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 2

Control Number 22-AS-20210706095734

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: 01/17/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA also conducted five resident interviews. Two out of five residents corroborated the allegation, and three out of five residents denied the allegation.
During resident interviews, LPA did not smell or otherwise detect odors consistent with incontinence. In addition, during record review, LPA obtained the facility’s shower schedule and verified showers were scheduled for residents in care. Information obtained during resident interviews was consistent with residents receiving showers as scheduled.
Based on interviews, record review, and observations, the preponderance of evidence standard was not met; therefore, the allegation is deemed unsubstantiated. An exit interview was conducted, and a copy of this report was provided to Operations Manager (OM) Jalessa Chavez.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2