306002455-1-6-2026-22-AS-APAO-DQE2DA-20260116161801

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306002455
Report Date: 01/06/2026
Date Signed: 01/06/2026 04:32:16 PM

Substantiated

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
12/30/2025 and conducted by Evaluator Fred Arias

COMPLAINT CONTROL NUMBER: 22-AS-20251230155600

FACILITY NAME:	INDEPENDENT OPTIONS INC/ANACAPA HOUSE		FACILITY NUMBER:	306002455
ADMINISTRATOR:	NOLETTE UNTALAN		FACILITY TYPE:	735
ADDRESS:	2538 ANACAPA DRIVE #105		TELEPHONE:	(714) 556-2591
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	4	CENSUS: 4	DATE:	01/06/2026
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Anna Liang		TIME COMPLETED:	04:46 PM

ALLEGATION(S):

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Facility did not meet the client's needs.
Staff did not treat client with respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.

It was alleged staff did not meet the client’s needs and staff did not treat client with respect. During the investigation, LPA conducted interviews with staff. LPA reviewed records received.

The investigation determined as follows: Regarding the allegation facility did not meet the client’s needs, it was reported S1 refused C1’s requests for beverages. LPA interviews with three out of six staff stated S1 would direct C1 to return to their room after asking for water or juice on multiple occasions. One out of the remaining three staff stated C1 would ask for water or juice but would tell C1 to wait until meal time to have a drink with their meal.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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 5

Control Number 22-AS-20251230155600

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: INDEPENDENT OPTIONS INC/ANACAPA HOUSE	FACILITY NUMBER: 306002455
	VISIT DATE: 01/06/2026

NARRATIVE

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The remaining two staff did not add anything relevant to the allegation. Record review revealed C1 has one dietary restriction for drinking non-fat milk but no other restrictions on liquids or how often C1 can have liquids are listed.

Regarding the allegation staff did not treat client with respect, it was reported staff yelled and used profanities towards a client. LPA interviews with three out of six staff stated staff 1 (S1) would direct client 1 (C1) to stay in their room using profanities in their language. Two out of the three staff added this occurred on several occasions. One out of the remaining three staff stated they did not witness S1 using profanity towards clients but did observe S1 either raising their voice or yelling at C1 on several occasions out of frustration. One out of the two remaining staff stated no profanities were ever directed at clients but profane language was used in standard conversation amongst staff members. The remaining staff did not add anything relevant to the allegation. Record review revealed S1 was disciplined on January 2, 2026 for “raising your voice and using profanity in the presence of co-workers and clients.”

Based on interviews conducted and record review, the preponderance of evidence standard has been met. Therefore, the above allegations are found to be SUBSTANTIATED.

California Code of Regulations, (Title 22, Division 6), are being cited on the attached LIC 9099D.

An exit interview was conducted and a copy of the report was left with the facility representative along with appeal rights.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 5

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
12/30/2025 and conducted by Evaluator Fred Arias

COMPLAINT CONTROL NUMBER: 22-AS-20251230155600

FACILITY NAME:	INDEPENDENT OPTIONS INC/ANACAPA HOUSE		FACILITY NUMBER:	306002455
ADMINISTRATOR:	NOLETTE UNTALAN		FACILITY TYPE:	735
ADDRESS:	2538 ANACAPA DRIVE #105		TELEPHONE:	(714) 556-2591
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	4	CENSUS: 4	DATE:	01/06/2026
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Anna Liang		TIME COMPLETED:	04:46 PM

ALLEGATION(S):

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Staff did not intervene during a client altercation.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

It was alleged staff did not intervene during a client altercation. During the investigation, LPA conducted interviews with staff.

The investigation determined as follows: Regarding the allegation staff did not intervene during a client altercation, it was reported Staff 1 (S1) did not intervene when another client attacked Client 1 (C1). One out of six staff stated there was an instance when S1 ran into one of the bedrooms when a client became agitated towards them and left another staff member alone to intervene between two clients. One out the remaining five staff stated they went to look for C1 during that same instance to prevent an altercation between clients but was unable to locate C1 in the bedroom and returned to the living room to intervene.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

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

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 22-AS-20251230155600

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: INDEPENDENT OPTIONS INC/ANACAPA HOUSE	FACILITY NUMBER: 306002455
	VISIT DATE: 01/06/2026

NARRATIVE

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Two out of the remaining four staff stated they have not observed S1 not intervene during altercations between clients. The remaining two staff did not add anything relevant to the allegation.

Based on staff interviews, the allegation staff did not intervene during a client altercation is therefore deemed unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of the report was left with the facility representative.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 22-AS-20251230155600

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: INDEPENDENT OPTIONS INC/ANACAPA HOUSE	FACILITY NUMBER: 306002455
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/06/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/20/2026 Section Cited CCR 80072(a)(3)	1 2 3 4 5 6 7	Personal Rights 80072(a)(3) To be free from... humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature... interference with the daily living functions, including eating... The requirement is not met as evidenced by:	1 2 3 4 5 6 7	AD stated in-service training will be provided to facility staff regarding beverages and client personal rights with regards to treatment of clients in the facility.
	8 9 10 11 12 13 14	C1 was spoken to in an inappropriate manner and was not provided beverages when asked which poses a potential personal rights risk to persons is care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 5