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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004477
Report Date: 09/09/2025
Date Signed: 09/09/2025 04:01:11 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
11/10/2021 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211110131224
FACILITY NAME:ROSIE HALL FAMILY HOMEFACILITY NUMBER:
306004477
ADMINISTRATOR:KARRY VALLEJOFACILITY TYPE:
735
ADDRESS:2031 S. ARTESIA STREETTELEPHONE:
(714) 831-1336
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY:4CENSUS: 4DATE:
09/09/2025
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Rey Inarin-AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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* Facility staff did not prevent Client from self harm
* Facility is not accepting Client back at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude the investigation into the above identified complaint allegations. LPA arrived at the facility and was greeted at the door and granted entry. LPA spoke with Rey Inarin, Administrator and explained the purpose of the visit.

Findings are based upon this investigation which included facility file review, and interviews conducted.

It is alleged that facility staff did not prevent a client from self-harm. Record review revealed that Client’s (C1) IPP dated July 14, 2021, page 7 RCOC is currently funding for Residential Program Support 1:1 at 12 hours per day, seven days per week to ensure C1’s safety. Interview with staff revealed that staff S1 is the assigned staff for C1’s 1:1 care. Staff stated that C1 is always on 1:1 care during waking hours as

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
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 2
Control Number 22-AS-20211110131224
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: ROSIE HALL FAMILY HOME
FACILITY NUMBER: 306004477
VISIT DATE: 09/09/2025
NARRATIVE
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per their IPP. Staff stated that despite of the 1:1 care C1 or any other client still deserves dignity, respect, and privacy when using the bathroom. The day of the incident staff walked in and out in two minutes, upon return staff found resident and immediately called for medical services and C1 was transferred to hospital for further evaluation.

It is alleged the facility is not accepting client back to the facility. Complaint details received on November 10, 2021. Record review revealed that UCI discharge paperwork dated November 11, 2021, C1 was discharged. Interview with S1 stated that C1 was discharged on November 11, 2021, and returned to the facility. Since then, C1 has been moved to a sister facility due to needing a higher level of care in which that facility can provide.

Based on the information mentioned above, the Department is unable to ascertain if the allegation 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, this allegation is deemed Unsubstantiated.

An exit interview was conducted with the Administrator and a copy of this LIC9099 report was left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2