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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000106
Report Date: 02/11/2026
Date Signed: 02/11/2026 04:41:08 PM

Substantiated


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
02/06/2026 and conducted by Evaluator Claudia Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260206103535
FACILITY NAME:PROMISES GUEST VILLAGEFACILITY NUMBER:
306000106
ADMINISTRATOR:DANTE ENCARNACIONFACILITY TYPE:
735
ADDRESS:1315-1321 ANAHEIM BLVD.TELEPHONE:
(714) 774-1544
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:40CENSUS: DATE:
02/11/2026
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Dante EncarnacionTIME COMPLETED:
04:55 PM
ALLEGATION(S):
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Staff did not accept client back after hospital stay.
Staff were not responsive to client’s care needs while hospitalized.
INVESTIGATION FINDINGS:
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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez. LPA met with Administrator (AD) Dante Encarnacion and explained the purpose of the inspection.

Regarding allegations, Facility did not accept client back after their hospital stay and Staff were not responsive to client’s care needs while hospitalized, the following was revealed: It is alleged the facility did not accept Client 1 (C1) following their hospital stay and were not responsive to C1’s needs during their hospitalization. On January 28, 2026, C1 was hospitalized due to hypoxia and pneumonia. As of today's date, C1 remains hospitalized. LPA conducted an interview with two facility staff and two witnesses. During their interview, two of two staff stated C1 was transported to the hospital via ambulance, and C1’s face sheet and current medication list was provided to the paramedics who transported C1 to the hospital. (Cont. LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
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-20260206103535
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: PROMISES GUEST VILLAGE
FACILITY NUMBER: 306000106
VISIT DATE: 02/11/2026
NARRATIVE
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Per two of two staff, C1 will not be returning to the facility following their hospital stay due to requiring a higher level of care and stated this information had been provided verbally by hospital staff, Witness 1 (W1). During their interview, W1 stated C1 did not arrive at hospital with a current medication list, or any other documentation. Per W1, they attempted to reach out to the facility on multiple occasions in order to obtain necessary documentation, however, their calls went unanswered. W1 stated C1 is ready to be discharged from the hospital and back to the facility, however, C1 remains at the hospital due to the facility refusing to accept them. During the course of the investigation, an interview was also conducted with C1's responsible party, Witness 2 (W2), who also corroborated the allegations and stated the facility had not been responsive to C1's care needs and refused to accept C1 following their hospitalization by verbally indicating C1 needed a higher level of care.

Based on interviews and records review, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end today's inspection.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260206103535
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: PROMISES GUEST VILLAGE
FACILITY NUMBER: 306000106
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/12/2026
Section Cited
CCR
85068.5(a)(4)
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85068.5 Eviction Procedures (a) The licensee shall be permitted to evict a client by serving the client with a 30-day written notice to quit...(4) A needs and services plan modification has been performed... which determined that the client's needs cannot be met...
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AD stated C1 will be immediately accepted back to the facility and a 30-day eviction notice will be issued and a copy provided to LPA via email by POC date.
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This requirement is not met as evidenced by:

Based on interviews, the Licensee did comply with section cited above as C1 was not issued a 30-day eviction notice and has not been accepted back to the facility following their hospital stay.
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Type A
02/12/2026
Section Cited
CCR
80078(a)
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80078 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement is not met as evidenced by:
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AD stated they will communicate with hosptial to ensure the resident's needs are met and proof will be provided to LPA via email by POC date.
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Based on interviews, the Licensee did comply with section cited above as staff were not responsive to client’s care needs while they were hospitalized.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3