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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300607356
Report Date: 06/27/2025
Date Signed: 06/27/2025 12:54:59 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
05/19/2023 and conducted by Evaluator Fred Arias
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230519131544
FACILITY NAME:CMC GROUP OF CO. INC. DBA.FACILITY NUMBER:
300607356
ADMINISTRATOR:CALUB, MYRNA V.FACILITY TYPE:
735
ADDRESS:2414 SOUTH PARK DR.TELEPHONE:
(714) 435-0876
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY:6CENSUS: 1DATE:
06/27/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Edgar BarridoTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Licensee is not maintaining required food supplies on the premises
Facility has expired food
Licensee is not maintaining updated client records
Licensee is not properly securing tools and chemicals
Facility is not kept free of obstructions
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to continue an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. An initial investigation visit was conducted on May 23, 2023 by LPA Jenifer Tirre. During the visit, LPA Tirre accompanied by staff conducted a tour of the physical plant. LPA Tirre conducted interviews with clients and staff, reviewed files, and requested pertinent documents.

It was alleged licensee is not maintaining required food supplies on the premises, facility has expired food, licensee is not maintaining updated client records, licensee is not properly securing tools and chemicals, and facility is not kept free of obstructions. During the investigation, LPA Arias conducted interviews with clients in care and staff. LPA Arias reviewed records obtained.

Continued on LIC9099-C dated 06/27/2025
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025
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 3
Control Number 22-AS-20230519131544
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: CMC GROUP OF CO. INC. DBA.
FACILITY NUMBER: 300607356
VISIT DATE: 06/27/2025
NARRATIVE
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The investigation determined as follows: Regarding the allegation licensee is not maintaining required food supplies on the premises , it was reported there was not enough food in the refrigerator or pantry . LPA Arias conducted an annual inspection on 06/20/2025 and observed at least two days of perishable food and at least seven days of nonperishable food at the facility. On this day, LPA Arias once again observed sufficient food available at the facility. The facility has a total of four refrigerators containing food on-site. Staff 1 (S1) stated licensee brings food to the facility at least twice a week.

Regarding the allegation facility has expired food, it was reported a fraction of food was expired. During the annual inspection conducted on 06/20/2025 and during today's investigation, LPA did not observe any expired food. LPA observed hand written expiration dates on nonperishable food. S1 stated they audit the expiration dates weekly and if there is ever any expired food discovered, it is disposed of. LPA interviewed client 1 (C1) and they stated food is of good quality and tastes good.

Regarding the allegation licensee is not maintaining updated client records, it was reported that the consent forms, emergency medical treatment forms, Client Developmental Evaluation Reports (CDERS), and Individual Program Plans (IPP's) for each resident, were not updated. LPA reviewed client records and found the following: C1's quarterly IPP was completed on 04/14/2025, annual IPP was completed on 10/30/2024, CDERS completed on 10/30/2024, consent form completed on 10/30/2024, and emergency medical treatment form completed on 10/30/2024. Client 2 (C2)'s quarterly IPP was completed on 06/06/2025, annual IPP was completed on 12/17/2024, CDERS completed on 12/17/2024, consent form completed on 12/23/2024, and emergency medical treatment form completed on 12/23/2024. Client 3 (C3)'s quarterly IPP was completed on 05/16/2025, annual IPP was completed on 11/25/2024, CDERS completed on 11/25/2024, consent form completed on 11/25/2024, and emergency medical treatment form completed on 11/25/2024. Client 4 (C4)'s quarterly IPP was completed on 06/06/2025, annual IPP completed on 03/14/2025, CDERS completed on 03/14/2025, consent form completed on 03/14/2025, and emergency medical treatment form completed on 03/14/2025.

Regarding the allegation the licensee is not properly securing tools and chemicals, it was reported that the backyard appeared in unsafe conditions, tools were not properly stored away, and neither were chemical sprays. During the annual inspection conducted on 06/20/2025 and during today's investigation, LPA did not observe any tools or chemicals not properly stored away. The facility was observed to be in a safe condition.

Continued on LIC9099-C dated 06/27/2025
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20230519131544
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: CMC GROUP OF CO. INC. DBA.
FACILITY NUMBER: 300607356
VISIT DATE: 06/27/2025
NARRATIVE
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Regarding the allegation facility is not kept free of obstructions, it was reported the garage is being used to store, what appears to be a kitchen remodel, cabinets and new appliances. During the annual inspection conducted on 06/20/2025 and during today's investigation, LPA did not observe any signs of a remodel taking place. LPA observed the garage organized and used in part as a TV theater room.

Therefore based on client interview, staff interview, records observed, and LPA observations, the allegations licensee is not maintaining required food supplies on the premises, facility has expired food, licensee is not maintaining updated client records, licensee is not properly securing tools and chemicals, and facility is not kept free of obstructions are therefore deemed unsubstantiated meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and a copy of the report was left with the facility representative.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3