306000889-7-20-2026-22-AS-LMOA-DX5459-20260819184735

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000889
Report Date: 07/20/2026
Date Signed: 07/20/2026 01:19:54 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
09/23/2025 and conducted by Evaluator Edward Kim

COMPLAINT CONTROL NUMBER: 22-AS-20250923132258

FACILITY NAME:	SENIOR LIVING COMMUNITY FOR THE EASTERN STAR IN CA		FACILITY NUMBER:	306000889
ADMINISTRATOR:	KAT FARRIS		FACILITY TYPE:	741
ADDRESS:	16850 E. BASTANCHURY ROAD		TELEPHONE:	(714) 577-9281
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	76	CENSUS: 29	DATE:	07/20/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Administrator Kat Farris		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff does not ensure pre-admission procedures are being followed.
Staff do not ensure residents are placed in correct level of care.

INVESTIGATION FINDINGS:

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On July 20, 2026, Licensing Program Analyst (LPA) Edward Kim conducted a subsequent complaint visit to deliver complaint investigation findings. LPA met with Administrator Kat Farris and explained the purpose of the visit.

The investigation consisted of the following. LPA Kim toured the facility. LPA requested and obtained copies of the resident and staff rosters. LPA Kim reviewed and obtained copies of resident roster, staff roster, and three resident’s records, which include: Admission Agreement, Identification and Emergency Information, Physician's Report, Needs and Services Plans/Reappraisal, and other pertinent records. LPA Kim conducted interviews with seven staff and five residents.

The investigation revealed the following:

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

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 4

Control Number 22-AS-20250923132258

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: SENIOR LIVING COMMUNITY FOR THE EASTERN STAR IN CA	FACILITY NUMBER: 306000889
	VISIT DATE: 07/20/2026

NARRATIVE

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Allegation: Staff does not ensure pre-admission procedures are being followed.

It is alleged Staff #2 (S2) is not following pre-admissions procedures. It is alleged S2 is admitting residents to assisted living when they should be placed in memory care. It is alleged resident #1 (R1) should have been placed in memory care from date of entry.

Based on record review, R1, R2, and R3, all had preplacement appraisals, admission agreement, facesheets, and medical assessments completed prior to moving into the facility. R1 moved into the facility on June 30, 2025, with a Preplacement Appraisal completed, Functional Capability Assessment dated June 25, 2025, and medical assessment completed on June 26, 2025. R2 moved into he facility one August 13, 2025, with a completed admission agreement on August 11, 2025, Preplacement Appraisal completed on August 11, 2025, Medical Assessment completed on August 12, 2025, and a Functional Capability Assessment completed on August 8, 2025. R3 moved into the facility on July 25, 2023 with a completed admissions agreement, completed medical assessment on May 1, 2023, preplacement appraisal completed on May 1, 2023, and completed Functional Capability Assessment.

Based on interviews conducted, three out seven of staff confirmed the allegation. Four out of seven staff denied the allegation. S1 stated that S2 has always completed the pre-admission’s procedures and made sure all Department of Social Services Title 22 regulations are being followed prior any resident being admitted to the facility. S1 stated that all residents are placed based on the help of admissions, care director staff, and others reviewing all documentation such as preplacement assessments, functional capability assessment, and medical assessment. Applicants and applicants responsible parties also play a vital role in determining if the resident fits in with the facility and providing the right level of care. Through talking with staff and applicants with examining all necessary documentation, the facility can make sure the applicant is a fit for the facility.

Based on the information gathered, the above allegation could not be corroborated. The records for R1, R2, and R3, show the facility has records of providing all necessary records prior to being admitted to the facility.
Allegation: Staff do not ensure residents are placed in correct level of care.
It is alleged residents who require memory care services are admitted to assisted living. It is alleged that the Administrator will not acknowledge Resident #2 (R2) and Resident #3 (R3) should be moved from assisted living to memory care.
Continued on LIC9099C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250923132258

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: SENIOR LIVING COMMUNITY FOR THE EASTERN STAR IN CA	FACILITY NUMBER: 306000889
	VISIT DATE: 07/20/2026

NARRATIVE

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Based on interviews conducted, four out of seven staff confirmed the allegation. Three out of five residents and three out of seven staff denied the allegation. Two out of five residents could not confirm or deny the allegation. S1 stated that residents are placed according to their level of care. The Level of Care is determined from the preadmissions procedure and a review of all their documentation. For R1, R2, and R3, they were placed to assisted living because of what the medical assessments, preplacement appraisals, functional capability assessment, and on interviews. There was nothing on the documentation or from the interviews that determined the residents required a care other then what they were admitted to.

Based on record review, R1’s move-in date is on June 30, 2025, from their admission agreement and their facesheet. Functional Capability Assessment dated June 25, 2025, stated R1 is an independent resident who can transfer themselves from in and out of bed, wears hearing aids, can reposition themself, can communicate, and uses a walker to ambulate. Preplacement Appraisal stated R1 uses their walker for safety and has a history of falls. It is noted that R1 is able to walk without any physical assistance, which includes not using a walker. The functional capabilities stated they use a walker. It is stated that the resident does not need help transferring in and out of bed and dressing and moving around the facility. The medical assessment dated June 26, 2025, states the resident has motor impairment and has a walker as an assistive device. R1 had seven falls from July 7, 2025, to August 31, 2025. Facility conducted an appraisal on August 18, 2025, and the resident had a new medical assessment on August 15, 2025. Through an assessment by facility it was determined that R1 would be a fit for Memory Care. S1 stated R1 did not agree with the assessment and moved out of the facility on September 25, 2025.

R2's move-in date on August 13, 2025, based on their admission agreement and facesheet. R2’s medical assessment dated August 12, 2025, diagnoses R2 with Atrial Fibrillation, hypertension, and mild cognitive impairment. It is also stated R2 does not have bowel incontinence, bladder incontinence, and has hallucinations. R2’s Preplacement Appraisal dated August 11, 2025, states resident needs physical assistance to walk with a walker. The Preplacement Appraisal states R2 does not need assistance transferring in and out of bed, moving around the facility, and special medical attention. R2’s resident appraisal dated September 9, 2025, stated R1 has a hearing loss and demonstrates confusion throughout the day. They have become lost in the facility. R2 needs a walker with assistance to get in and out of it. Functional Capability Assessment dated September 18, 2025, stated resident has a severe hearing loss and is very confused at times. R2 moved into memory care due to increased confusion and severe hearing loss.
Continued on LIC9099C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20250923132258

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: SENIOR LIVING COMMUNITY FOR THE EASTERN STAR IN CA	FACILITY NUMBER: 306000889
	VISIT DATE: 07/20/2026

NARRATIVE

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R3 moved into the facility on July 25, 2023 based on their admission agreement and facesheet. R3’s medical assessment dated May 1, 2023, diagnoses R3 with Mild Cognitive Impairment and is able to bathe themselves, dress themselves, and take care of their own toileting needs. R3 was being taken care by their spouse from July 25, 2023, until July, 3, 2026. R3 was diagnosed with dementia from their medical assessment dated February 12, 2026. It is noted that the spouse would be helping R3 with all their daily needs. With the care and supervision from the spouse, R3 remained in Assisted Living as needed. As of July 3, 2026, R3 was placed in memory care because it was determined R3 needed assistance beyond the capabilities R3’s spouse could provide.

Based on information gathered, the above allegation could not be corroborated. The records for R1, R2, and R3, show the facility placed residents on the level of care they needed from admission. As the needs changed of the residents, the facility responded to provide the level of care needed for each of the resident.

Based on observations, interviews, and records review, LPA did not find sufficient evidence to support the above allegations Staff does not ensure pre-admission procedures are being followed and Staff do not ensure residents are placed in correct level of care. Although the 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 the allegations are Unsubstantiated.

Exit interview was conducted and a copy of the report was provided to Administrator Kat Farris

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

LIC9099 (FAS) - (06/04)

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