306004718-12-30-2025-22-AS-AORZ-DPY2MA-20260102163046

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004718
Report Date: 12/30/2025
Date Signed: 12/30/2025 04:19:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/06/2021 and conducted by Evaluator Andrea Mendivil

COMPLAINT CONTROL NUMBER: 22-AS-20210506092620

FACILITY NAME:	GROVES OF TUSTIN, THE		FACILITY NUMBER:	306004718
ADMINISTRATOR:	LIANA FOOTE		FACILITY TYPE:	740
ADDRESS:	1262 BRYAN AVE		TELEPHONE:	(714) 730-5009
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	100	CENSUS: 68	DATE:	12/30/2025
		UNANNOUNCED	TIME BEGAN:	02:46 PM
MET WITH:	Susan Ruiz Hidalgo - Executive Director		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff failed to supervise resident resulting in multiple falls and injuries

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an uannounced visit to deliver complaint findings. LPA was greeted and granted entry into the faciltiy by staff and explained the reason for the visit.

The Department recieved the complaint on 05/06/2021 and LPA Martinez conducted the initial 10 day visit on 05/17/2021 via telephone due to COVID procedures. LPA Mendivil conducted interviews on 11/19/2025. Regarding the allegation staff failed to supervise resident resultling in multiple falls and injuries, the investigation revealed the following:

It was alleged that Resident 1 (R1) had multiple falls while at the facilty from 2020 to 2021. Based on interview with staff R1 passed away at the facility on 01/16/2021. Per interviews with 4 out of 4 staff that worked at the faciltiy in 2021 stated they were able to meet residents needs and they did not neglect residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

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-20210506092620

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GROVES OF TUSTIN, THE	FACILITY NUMBER: 306004718
	VISIT DATE: 12/30/2025

NARRATIVE

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Interviews with 7 out of 7 residents stated their needs are met and staff is not neglectful. Based on interviews with residents they stated that the staff is very helpful and responsive.

Interviews with Memory Care Director Alma Gomez stated if someone is a fall risk the facility will implement the following: review medications , check for UTI's or other health conditions, review of flooring and lighting and ensure there are zero tripping hazards. Alma stated they will also check resident's shoe wear to ensure they are non-slip and properly worn. Alma stated if a fall risk is due to gait then the facility will have resident in physical therapy to improve gait, if possible.

Therefore based on the preponderance of evidence through interviews the allegation that resident Staff failed to supervise resident resulting in multiple falls and injuries is determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

No deficiencies cited.
An exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025

LIC9099 (FAS) - (06/04)

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