306004718-8-13-2025-22-AS-AORZ-DKZNWG-20250829104931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004718
Report Date: 08/13/2025
Date Signed: 08/13/2025 03:44:28 PM

Unfounded

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
08/08/2025 and conducted by Evaluator Andrea Mendivil

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250808091206

FACILITY NAME:	GROVES OF TUSTIN, THE		FACILITY NUMBER:	306004718
ADMINISTRATOR:	MCBRIDE, FERLINA		FACILITY TYPE:	740
ADDRESS:	1262 BRYAN AVE		TELEPHONE:	(714) 730-5009
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	100	CENSUS: 74	DATE:	08/13/2025
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Wendy Cruz - Executive Director and Alma Gomez - Memory Care Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Medication not administered as prescribed
Facility staff did not allow resident to participate in activities
Facility violated resident's rights

INVESTIGATION FINDINGS:

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On this Day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

The Department received a complaint on 08/08/2025. LPA Mendivil conducted the 10 day visit on 08/13/2025. During the visit LPA Mendivil obtained copies of pertinent documents such as Resident 1's (R1) physician report, admission agreement , theft and loss policy and activities sign up sheets. LPA Mendivil also interviewed staff and residents. Regarding the allegations Medication not administered as prescribed,Facility staff did not allow resident to participate in activities and Facility violated resident's rights, the investigation revealed the following:

CONT on LIC 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

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 4

Control Number 22-AS-20250808091206

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: 08/13/2025

NARRATIVE

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It is alleged that the facility did not administer medication as prescribed on or around 07/29/2025 for R1. Per interviews with Memory Care Director Alma Gomez, R1 had complained of pain of her hands to med tech staff. Alma stated then med-tech staff reported the issue to R1's primary care physician (PCP) office who then told med tech staff that they were going to send a prescription over to the pharmacy. It was then reported on 07/31/2025 Med-tech staff called PCP's office to follow up on the prescription and was told by PCP's office that they will send it over on 07/31/2025. Alma stated the facility received the medication from the pharmacy on 07/31/2025 in the PM and it was administered per physician's orders on 08/01/2025.

It was alleged that the facility staff did not allow resident to participate in activities. Based interview with Alma stated she has never denied a memory care resident participation in a memory care outing. Alma stated that assisted living and memory care have their own outings as their care levels are different. Alma stated there are only 8 seats on the bus and availability is limited so the activity staff tries to rotate residents that want to participate. During the visit LPA Mendivil observed memory care residents on the first floor waiting for the bus to take them on their outing.

It was alleged the facility violated residents rights. Based on interviews with 6 out of 6 staff stated they do not violate residents rights including: forcing a resident to wake up earlier than wanted or to participate in activities they do not wish to. LPA Mendivil interviewed 2 memory care residents that stated no one has violated their rights.

Therefore based on the preponderance of evidence through records reviewed, observations and interviews the allegations Medication not administered as prescribed, Facility staff did not allow resident to participate in activities and Facility violated resident's rights are determined to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit Interview conducted and a copy of this report was provided.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
08/08/2025 and conducted by Evaluator Andrea Mendivil

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250808091206

FACILITY NAME:	GROVES OF TUSTIN, THE		FACILITY NUMBER:	306004718
ADMINISTRATOR:	MCBRIDE, FERLINA		FACILITY TYPE:	740
ADDRESS:	1262 BRYAN AVE		TELEPHONE:	(714) 730-5009
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	100	CENSUS:	DATE:	08/13/2025
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Wendy Cruz - Executive Director and Alma Gomez - Memory Care Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility did not safeguard resident's property

INVESTIGATION FINDINGS:

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On this Day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

The Department received a complaint on 08/08/2025. LPA Mendivil conducted the 10 day visit on 08/13/2025. During the visit LPA Mendivil obtained copies of pertinent documents such as Resident 1's (R1) physician report, admission agreement , theft and loss policy and activities sign up sheets. LPA Mendivil also interviewed staff and residents. Regarding the allegation facility did not safeguard resident's property, the investigation revealed the following:

It was alleged that the facility did not safeguard resident's property on or around 07/1/2025. It was alleged that R1 was missing items. Based on review of facility lost and found it was reported that on 07/02/2025 a "marquee ring" was missing and on 07/31/2025 it was noted a "pearl ring and various tops" were missing.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20250808091206

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: 08/13/2025

NARRATIVE

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Per review of LIC 621 Client/Resident Personal Property and Valuables for R1 has one item logged as " wedding ring". Per interviews with Memory Care Director Alma Gomez stated that around 07/02/2025 after marquee ring was reported missing the memory care staff checked R1's room and were unable to locate the ring. Based on interview with Alma and Executive Director Wendy Cruz they inspected R1's on 08/06/2025 to search for the pearl ring which they could not locate. Alma stated asked R1's family to provide information regarding the missing rings and missing tops, and was provided that information on 08/08/2025 via email. On 08/11/2025 Alma along with Staff 1 (S1) went into R1's room and were able to locate all but two tops.

Per interviews with Alma the facility has conducted an investigation which resulted in no findings. Per Alma the Tustin PD was notified and reached out to her on 08/06/2025 inquiring about the missing items, per Alma no case number was provided. Interviews with 5 out of 5 staff stated they did not take any items from R1. Interviews with 2 out of 3 residents stated they have not had items taken, the final resident was not oriented to time and space and could not answer LPA's questions.

Therefore based on the preponderance of evidence through records reviewed the allegation that Facility did not safeguard resident's property 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 and confidential names list was provided

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025

LIC9099 (FAS) - (06/04)

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