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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300612904
Report Date: 06/19/2025
Date Signed: 06/19/2025 03:41:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/13/2025 and conducted by Evaluator Claudia Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250613111418
FACILITY NAME:ADELINE GUEST HOMEFACILITY NUMBER:
300612904
ADMINISTRATOR:ADELINA MONCERAFACILITY TYPE:
740
ADDRESS:741 N. EAST STREETTELEPHONE:
(714) 996-0568
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:6CENSUS: 5DATE:
06/19/2025
UNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Christian "CJ" Catacutan
Janice Jabanero		TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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The facility’s bathroom was not clean and was unsanitary.
The facility faiiled to eradicate pests.
The facility did not safeguard resident's personal property.
INVESTIGATION FINDINGS:
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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegations mentioned above. LPA met with Assistant Administrator (AAD) Janice Jabonero and House Manager Ana Cacho and explained the purpose of the inspection.

Interviews were conducted with three facility staff and five of five residents, regarding the allegation the facility’s bathroom was not clean and was unsanitary. Three of three staff stated the bathrooms are clean and sanitary, and staff clean multiple times a day to ensure cleanliness. Four of five residents stated the facility bathrooms are clean and sanitary. One of five residents stated the facility bathrooms are not clean or sanitary as they have seen cockroaches there and in their bedroom. During today’s inspection, LPA conducted a tour of the facility, including two of two bathrooms. LPA did not observe any cockroaches and observed bathrooms to be free of debris and mildew, and faucets and toilets were operational. (Cont. LIC9099-C)

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
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-20250613111418
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ADELINE GUEST HOME
FACILITY NUMBER: 300612904
VISIT DATE: 06/19/2025
NARRATIVE
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Interviews were conducted with three facility staff and five of five residents, regarding the allegation the facility failed to eradicate pests. Three of three staff stated there are no pest including cockroaches. LPA was provided with a copy of Service Agreement between the facility and a pest control company dated April 30, 2025. Per Service Agreement, between April and October the pest control company will provide treatment every 20-40 days and between November and March they will provide treatment every 50-80 days. Two of five residents denied ever seeing any pest, including cockroaches in the facility. One of five residents stated they have only seen one small cockroach since they have been at the facility but were unable to recall when they had seen it. One of five residents stated they saw a cockroach about five days ago, and stated they believed someone visiting a resident may have inadvertently brought it in, because they had not observe any other cockroaches prior or since. One of five residents stated the facility had cockroaches in the bathrooms and residents’ rooms approximately two weeks ago, but an exterminator was contracted, and the cockroaches were eradicated. During today’s inspection, LPA conducted a tour of the facility, including resident bedrooms and bathrooms. LPA did not observe any pest, including cockroaches.

Interviews were conducted with three facility staff and five of five residents, regarding the allegation the facility did not safeguard resident’s personal property. It is alleged a former resident’s turquoise towel and phone charger were not returned to them upon discharge. Three of three staff stated that upon admission a list of resident’s personal property and valuables is created and denied any current or former resident reporting any missing property or valuables. Five of five residents denied any of their personal belongings being missing or unaccounted for. During today’s inspection, LPA conducted a tour of the facility and observed facility storage areas, including the linen closet. LPA did not observe a turquoise towel or a phone charger in these areas.

Due to allegations being uncorroborated during interviews conducted, and after a physical inspection of the facility, LPA is unable to determine if the facility’s bathroom was not clean and was unsanitary, if the facility failed to eradicate pests, or if the facility did not safeguard resident’s personal property. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore at this time the above allegations are unsubstantiated.

An exit interview was conducted and copy of this report was provided at the end of the inspection.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2