300602548-1-24-2026-22-AS-APAO-DR38L7-20260206213615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300602548
Report Date: 01/24/2026
Date Signed: 01/24/2026 10:46:38 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
01/19/2022 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20220119101046

FACILITY NAME:	KATELLA SENIOR LIVING COMMUNITY		FACILITY NUMBER:	300602548
ADMINISTRATOR:	LINDSAY SCHROEDER		FACILITY TYPE:	740
ADDRESS:	3952 KATELLA AVENUE		TELEPHONE:	(562) 596-2773
CITY:	LOS ALAMITOS	STATE: CA	ZIP CODE:	90720
CAPACITY:	140	CENSUS: 54	DATE:	01/24/2026
		UNANNOUNCED	TIME BEGAN:	08:12 AM
MET WITH:	Jalessa Chavez		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff under the influence providing care to resident
Facility did not provide a safe environment for resident
Staff left hazardous items accessible to residents
Staff did not change resident's surgical dressing to keep clean and dry
Staff are not allowing private caregiver into facility to provide care to resident
Resident's toilet plugs
Staff do not ensure resident's room clean
Resident's room has insects

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver the findings regarding the above-mentioned allegations. Upon arrival, LPA Haddadin explained the purpose of the visit and was greeted by Operations Manager (OM) Jalessa Chavez.
As part of the investigation, LPA Haddadin toured the facility’s physical plant, conducted interviews, and requested copies of pertinent records for review. During the investigation, LPA Haddadin requested resident and staff records; however, pursuant to Title 22, California Code of Regulations, section 87506(e), Residential Care Facilities for the Elderly (RCFEs) are required to maintain resident records for a period of three years. As a result, LPA Haddadin was not able to obtain files pertaining to this investigation. {***CONTINUE 9099C***}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

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 3

Control Number 22-AS-20220119101046

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: 01/24/2026

NARRATIVE

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It was alleged that "Staff under the influence providing care to resident", "Staff left hazardous items accessible to residents", and "Facility did not provide a safe environment for resident". LPA Haddadin conducted five staff interviews and five resident interviews, and the interviewees did not corroborate these allegations. LPA Haddadin reviewed staff files and did not observe documentation indicating any staff member was terminated or reprimanded for being impaired or under the influence. LPA Haddadin also completed a facility walkthrough and conducted a health and safety inspection and did not observe unsafe items or hazardous materials. The hallways were clear of obstacles. LPA Haddadin inspected five resident rooms and observed the rooms to be free of mold, mildew, and insects.
It was also alleged that "Resident’s toilet plugs", "Staff do not ensure resident’s room clean", and "Resident’s room has insects". LPA Haddadin inspected five resident rooms and did not observe insects. The rooms inspected were clean and well-maintained, with no unusual odors, and the walls and carpets were free of stains. LPA Haddadin inspected resident restrooms and observed the toilets to be operable and unclogged. During record review, LPA Haddadin observed the facility contracts with an outside pest control company that provides services twice per month, with the most recent service date on file documented as January 16, 2026. LPA Haddadin also observed documentation reflecting that resident rooms are maintained on a weekly cleaning schedule. During resident interviews, LPA Haddadin confirmed residents reported the facility follows a weekly cleaning schedule and responds when residents request additional cleaning. It was further alleged that "Staff did not change resident’s surgical dressing to keep clean and dry" and "Staff are not allowing RP into facility to provide care to resident". LPA Haddadin conducted five staff interviews and five resident interviews, and the interviewees denied these allegations. During staff file review, LPA Haddadin obtained documentation reflecting Med-Tech training and observed the facility was current with staff training records. {***CONTINUE 9099C***}

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20220119101046

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: 01/24/2026

NARRATIVE

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LPA Haddadin also confirmed that the private caregiver for resident 1 (R1) was associated with the facility through the Guardian system; which means they were fingerprinted and cleared to be in the facility to provide service to R1. LPA Haddadin conducted a phone interview with the private caregiver on January 24, 2026, and the private caregiver declined to provide a statement.
Based on interviews, record review, and observations, the preponderance of evidence standard was not met; therefore, the allegations are 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: 01/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2026

LIC9099 (FAS) - (06/04)

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