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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001408
Report Date: 11/18/2025
Date Signed: 11/18/2025 03:48:52 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
09/19/2025 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250919150730
FACILITY NAME:PARK PLAZAFACILITY NUMBER:
306001408
ADMINISTRATOR:BENJAMIN DAVISFACILITY TYPE:
740
ADDRESS:620 S. GLASSELL STREETTELEPHONE:
(714) 997-5355
CITY:ORANGESTATE: CAZIP CODE:
92866
CAPACITY:115CENSUS: 95DATE:
11/18/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Executive Director Benjamin DavisTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Lack of care and supervision resulted in resident sustaining a fall with injuries.
Staff did not seek timely medication attention for resident after sustaining fall.
INVESTIGATION FINDINGS:
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On November 18, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to deliver the findings of the complaint investigation into the allegations listed above. LPA met with Executive Director Benjamin Davis and explained the reason for the visit. During the course of the investigation, LPA inspected the facility, interviewed staff and residents, obtained and reviewed resident records.

Regarding the allegation that, lack of care and supervision resulted in resident sustaining a fall with injuries, the following has been concluded: Resident #1 (R1) was admitted to the facility on June 5, 2025. Per R1’s Physician’s report dated May 20, 2025, R1 is diagnosed with Mild Cognitive Impairment and had a medical history of skin cancer, eye disease, heart disease, seizure disorder, and had a pacemaker. R1 is ambulatory; able to follow instructions; able to leave the facility unassisted; able to bathe self; able to dress/groom self; able to dine independently; able to care for own toileting needs; and is able to manage own cash resources. CONTINUED ON LIC9099-C
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
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 3
Control Number 22-AS-20250919150730
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: PARK PLAZA
FACILITY NUMBER: 306001408
VISIT DATE: 11/18/2025
NARRATIVE
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Per R1’s care plan dated September 10, 2025, R1 has a diagnosis of mild cognitive impairment, congestive heart failure, atrial fibrillation, obstructive airway disease, and had a pacemaker. R1 was receiving assistance with medication, required escorts to all meals and activities of choice, and wears a wander guard for safety. Per R1’s charting notes dated September 19, 2025, R1 had an unwitnessed fall in his apartment and was found by staff on the floor around 7:30 AM. R1 was transported to the hospital for his injuries and was admitted for syncope and collapse. R1 remained in the hospital from September 19, 2025, to October 5, 2025. R1 returned to the facility on October 5, 2025, after being discharged from the hospital and was admitted under hospice with a primary diagnosis of end stage heart failure. R1 passed away on October 5, 2025. Per R1’s certificate of death, the listed causes of death are cardiopulmonary arrest and congestive heart failure. Based on a review of R1’s records, there were no records that indicated R1 was a fall risk and there were no records indicating that R1 has any previous recorded falls at the facility. Additionally, R1 did not require hourly checks by staff. LPA conducted six staff interviews. Six out of the six staff interviews conducted confirmed that the fall on September 19, 2025, was R1’s first fall while at the facility. The staff interviews conducted also denied R1 being considered a fall risk. Furthermore, it was revealed during staff interviews that R1 was provided with a call pendant upon move in which he could press to call for assistance from staff. However, R1 was not wearing his call pendant on the morning of September 19, 2025, and staff later found R1’s call pendant in his kitchen cabinet.

Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegations 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, the allegation is deemed UNSUBSTANTIATED.

Regarding the allegation that, staff did not seek timely medication attention for resident after sustaining fall, the following has been concluded: LPA reviewed R1’s charting notes dated September 19, 2025, which stated that R1 had an unwitnessed fall in his apartment and was found by staff on the floor around 7:30 AM. The charting notes stated that Staff #4 (S4) found R1 on the floor and that Staff #1 (S1) called 911 to seek medical attention for R1. LPA conducted an interview with both S1 and S4. Both staff interviewed denied the allegation and denied any delay in seeking medical attention for R1 after he was discovered on the floor. LPA reviewed S1’s personal cell phone call log and observed 911 was called at 7:37 AM on September 19, 2025, which is approximately seven minutes after R1 was discovered on the floor by staff.

CONTINUED ON LIC9099-C

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250919150730
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: PARK PLAZA
FACILITY NUMBER: 306001408
VISIT DATE: 11/18/2025
NARRATIVE
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Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegations 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, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with Executive Director Benjamin Davis and a copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3