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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000523
Report Date: 05/29/2025
Date Signed: 05/29/2025 08:38:33 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
02/25/2022 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220225142403
FACILITY NAME:ANAHEIM GUEST HOMEFACILITY NUMBER:
306000523
ADMINISTRATOR:EVELYN ENCARNACIONFACILITY TYPE:
735
ADDRESS:127 W. HILL PLTELEPHONE:
(714) 776-3075
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:40CENSUS: 38DATE:
05/29/2025
UNANNOUNCEDTIME BEGAN:
07:20 AM
MET WITH:Evelyn Encarnacion, Administrator
Maryann Alcanar, caregiver		TIME COMPLETED:
09:10 AM
ALLEGATION(S):
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Facility abandoned resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to deliver findings related to the investigation of the complaint allegation identified above. LPA arrived at facility and was greeted at the door and granted entry by staff. LPA spoke with Evelyn Encarnacion, Administrator and explained the purpose of the visit.

During the course of the investigation, interviews were conducted, a tour of the physical plant of the facility was conducted, a review of resident records was completed and copy of pertinent documents obtained.
It is alleged facility abandoned resident at the hospital. LPA conducted a facility visit on March 2, 2022, where LPA was informed and observed resident was residing at the facility. Interview with staff 1 (S1) stated that resident 1 (R1) was sent out to the hospital on February 3, 2022, via paramedics. S1 received

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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-20220225142403
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: ANAHEIM GUEST HOME
FACILITY NUMBER: 306000523
VISIT DATE: 05/29/2025
NARRATIVE
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a call from the hospital that R1 would be discharged as to S1 informed R1 responsible party of the status of R1 as to S1 was told that they would be picking up R1 from hospital. Hospital upon speaking with responsible party indicated that they were not picking up R1. However, on February 26, 2022, R1 returned to the facility by responsible party and was informed that they had picked up R1 from hospital to bring back to the facility. Based on the conflicting information received from interviews, the lack of information regarding incident, and lack of corroborating witness to the incident, LPA is unable to determine if the alleged violation occurred as reported.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted with facility representative and a copy of this LIC9099 report was left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2