306000752-4-14-2026-22-AS-APAO-DTA4P3-20260418191603

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000752
Report Date: 04/14/2026
Date Signed: 04/14/2026 04:34:40 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
01/21/2026 and conducted by Evaluator Andrea Mendivil

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260121131042

FACILITY NAME:	ATRIA GOLDEN CREEK		FACILITY NUMBER:	306000752
ADMINISTRATOR:	JEREMY GILMORE		FACILITY TYPE:	740
ADDRESS:	33 CREEK RD		TELEPHONE:	(949) 786-5665
CITY:	IRVINE	STATE: CA	ZIP CODE:	92604
CAPACITY:	155	CENSUS: 118	DATE:	04/14/2026
		UNANNOUNCED	TIME BEGAN:	01:01 PM
MET WITH:	Jeremy Gilmore - Executive Director		TIME COMPLETED:	03:03 PM

ALLEGATION(S):

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Facility did not prevent resident falls due to lack of staffing

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analysts (LPAs) Andrea Mendivil and Kimberly Lyman conducted an uannounced visit to deliver complaint findings. LPAs were greeted and granted entry into the facility by staff and explained the reason for the visit.

The Department received a complaint on 01/21/2026 and LPA Mendivil conducted the initial 10 day visit on 01/30/2026. During the course of the investigation LPAs interivewed staff and residents and obtained copies of resident records including service plan and physician's reports. Regarding the allegation faciltiy did not prevent resident falls due to lack of staff the investigaiton revealed the following:

Per interview with Executive Director Jeremy Gilmore the current staffing levels for Memory Care is as follows: for AM 5 staff including 4 caregivers and 1 med-tech, PM 5 staff including 4 caregivers + 1 med-tech, and NOC 3 staff including 2 caregiver and 1 med-tech. Per interviews with 5 out of 5 staff stated they are able to meet residents needs and there are no issues with staffing.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20260121131042

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: ATRIA GOLDEN CREEK	FACILITY NUMBER: 306000752
	VISIT DATE: 04/14/2026

NARRATIVE

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Per interviews with 2 out of 2 residents stated staff assisted them in a timely manner and their needs are met. Per review of Resident 1's (R1) physician report resident does not have motor impairment. Per service care plan R1 requires minimal fall assistance, per ED minimal assistance means escorting to and from dining and activities. Per review of incident reports R1 had 3 falls in between 02/13/2025 to 1/20/2026, R1 was taken to the hospital after each fall and R1's primary care physician was notified. The last fall occurred on 01/20/2026 around 1:00 PM, the resident was found on the activity room floor in Memory Care. R1 stated they were attempting to sit in a chair, missed the chair, and fell backward. Per incident report resident was sent out to the hospital after being assessed and assisted by staff at the facility.

Therefore based on the preponderance of evidence through records reviewed and interviews the allegation Facility did not prevent resident falls due to lack of staffing is determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

No deficiencies cited.
An exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026

LIC9099 (FAS) - (06/04)

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