306003515-5-14-2026-22-AS-AORZ-DUPKAA-20260603074333

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003515
Report Date: 05/14/2026
Date Signed: 05/14/2026 11:03:25 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
11/14/2025 and conducted by Evaluator Michael Tea

COMPLAINT CONTROL NUMBER: 22-AS-20251114111002

FACILITY NAME:	MARY'S ASSISTED HOME LIVING		FACILITY NUMBER:	306003515
ADMINISTRATOR:	MAUREEN SALONGA		FACILITY TYPE:	740
ADDRESS:	11642 DALE STREET		TELEPHONE:	(714) 537-0899
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY:	6	CENSUS: 1	DATE:	05/14/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Dorbin Santos		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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- Facility staff did not provide continence care to resident
- Facility verbally aggressive to resident

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit to conclude and deliver findings for a complaint investigation. LPA Tea was greeted and granted entry by facility staff and informed them of the purpose of the visit. Assistant Administrator (AA) Dorbin Santos arrived shortly to assist with the visit.

The Department received a complaint on November 14, 2025. During the investigation, LPA Tea conducted interviews with facility staff, residents, and witnesses, and reviewed facility records, resident documentation, and other relevant information.

It was alleged that facility staff did not provide continence care to resident. Based on interviews conducted, AA Santos and two caregiver staff stated that residents are provided with regular continence care,
(Complaint report continued on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

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-20251114111002

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: MARY'S ASSISTED HOME LIVING	FACILITY NUMBER: 306003515
	VISIT DATE: 05/14/2026

NARRATIVE

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including frequent diaper checks and changes throughout the day. Staff reported that Resident 1 (R1) and other residents are checked at routine intervals, including morning, mealtimes, and evening, and are changed as needed. Staff also stated that they assist residents with repositioning to help prevent skin breakdown.

One resident who shares a room with R1 reported that staff provide good care and that residents are not left in soiled diapers. However, another resident reported that they were not always changed in a timely manner and experienced a diaper rash that developed into a fungal infection. Additionally, one witness stated that while the facility provides general care, it may not be adequate for continence needs.

It was alleged that facility is verbally aggressive to resident. Interviews with three staff indicated that staff do not yell at or verbally mistreat residents. Staff reported that one staff member speaks in a louder tone due to hearing difficulties, which may be perceived as yelling. Staff stated they were not aware of any verbal abuse occurring at the facility.

Interviews with residents revealed that two out of three residents stated staff are kind and respectful, and they did not recall any incidents of verbal aggression. One resident reported that a staff member made inappropriate comments regarding their size and weight. A witness interviewed did not observe any verbal aggression and only reported hearing about the concern from R1.

Based on observations, interviews conducted, and records reviewed, conflicting information was obtained during the investigation, and there is insufficient evidence to support or refute the allegations. Therefore, the allegations are determined to be UNSUBSTANTIATED, meaning that although the allegations may have occurred or may be valid, there is not a preponderance of evidence to establish that the alleged violations occurred.

No deficiencies were cited at this time. An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

LIC9099 (FAS) - (06/04)

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