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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004672
Report Date: 07/09/2026
Date Signed: 07/09/2026 10:37:06 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
08/07/2023 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230807103330
FACILITY NAME:MEADOWLARK GARDENS ON CORNELLFACILITY NUMBER:
306004672
ADMINISTRATOR:CHRISTINE WILKESFACILITY TYPE:
740
ADDRESS:6112 CORNELL DRIVETELEPHONE:
(714) 248-9021
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 6DATE:
07/09/2026
UNANNOUNCEDTIME BEGAN:
07:14 AM
MET WITH:Administrator Ron WilkesTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Staff did not ensure that resident's oxygen equipment was operable during a power outage.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jenifer Tirre, met with Administrator Ron Wilkes for the purpose of delivering findings for the above allegations. The investigation consisted of records obtained and interviews conducted. On August 7, 2023, the department received allegations that Staff did not ensure that residents equipment was operable during a power outage. The investigation was completed by the department and revealed the following:

Per facility records, Facility Emergency Disaster Plan displays diagrams and photos for staff to know how to indicate if a electricity or gas valve is turned on or off. Emergency Disaster plan also states that in the event of a power outage Caregivers 1 & 2 are trained in putting residents on portable oxygen tanks and to notify Administrator and Licensing. Per facility Disaster checklist states that in the event of a power failure, the Safety Monitor is to switch Oxygen Concentrators to backup Oxygen tanks. Per facility interviews, Staff stated that Staff are trained on how to follow facility protocol for power outages. Staff stated that facility protocol is to put residents on portable oxygen tanks immediately. CONTINUED ON 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
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 2
Control Number 22-AS-20230807103330
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: MEADOWLARK GARDENS ON CORNELL
FACILITY NUMBER: 306004672
VISIT DATE: 07/09/2026
NARRATIVE
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Per interviews Staff 2 stated they could recall home having one power outage at the time around complaint was received stated that outage only lasted 10-15 minutes before power was restored.

Based on information gathered from investigation, there is not enough information to determine if allegation occurred as reported deeming allegation Staff did not ensure that residents equipment was operable during a power outage to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted with Administrator Ron Wilkes and copy of report was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2