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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004718
Report Date: 10/09/2025
Date Signed: 10/09/2025 04:05:02 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
01/13/2025 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250113161104
FACILITY NAME:GROVES OF TUSTIN, THEFACILITY NUMBER:
306004718
ADMINISTRATOR:MCBRIDE, FERLINAFACILITY TYPE:
740
ADDRESS:1262 BRYAN AVETELEPHONE:
(714) 730-5009
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:100CENSUS: 70DATE:
10/09/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Wendy Cruz - Executive Director TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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8
9
Staff do not serve residents foods of good quality
INVESTIGATION FINDINGS:
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5
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10
11
12
13
On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility and explained the reason for the visit.

The Department received a complaint on 01/13/2025 and the initial 10 day visit was conducted on 01/23/2025. LPA Mendivil and LPA Arias interviewed staff and residents and obtained copies of pertinent documents such as facility menu, staff schedules and resident roster. Regarding the allegations that staff do not serve residents food of good quality, the investigation revealed the following:

It was alleged that the facility does not serve food of good quality. Based on observations, LPA Mendivil toured facility kitchen and food prep area on 01/13/2025 and 10/09/2025. LPA Mendivil did not observe any expired food and the kitchen and equipment were cleaned and maintained. LPA Mendivil observed fridges’ temperatures were within range.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
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 4
Control Number 22-AS-20250113161104
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: 10/09/2025
NARRATIVE
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 Based on interviews with Juana Mejia, Food Service Director, it was reported that food deliveries are on Monday and Thursday for Sysco and Sunrise produce is delivered as needed. Interviews with Juana reported that all serving staff have their food handlers card. Interviews with 4 out of 5 residents stated the food was fine and the last resident stated the food was cold earlier in the day on 01/13/2025.

Therefore based on interviews and observations the allegation that Staff do not serve residents foods of good quality 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: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
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
01/13/2025 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20250113161104

FACILITY NAME:GROVES OF TUSTIN, THEFACILITY NUMBER:
306004718
ADMINISTRATOR:MCBRIDE, FERLINAFACILITY TYPE:
740
ADDRESS:1262 BRYAN AVETELEPHONE:
(714) 730-5009
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:100CENSUS: DATE:
10/09/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:TIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff confines resident to bedroom
Staff do not maintain sanitary facility
Staff do not ensure that resident has access to personal belonging
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility and explained the reason for the visit.

The Department received a complaint on 01/13/2025 and the initial 10 day visit was conducted on 01/23/2025. LPA Mendivil and LPA Arias interviewed staff and residents and obtained copies of pertinent documents such as facility menu, staff schedules and resident roster. Regarding the allegations that staff confines residents to bedroom, staff do not maintain a sanitary facility and staff do not ensure that residents has access to personal belongings, the investigation revealed the following:

It was alleged that staff confines residents to their bedrooms. Based on interviews with 4 out of 5 residents it was stated they have not been confined to their rooms the 5th resident was temporarily bed bound. Interviews with 4 out of 4 staff indicated they have never confined a resident to their rooms.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20250113161104
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: 10/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
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11
12
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It is alleged that the facility is not sanitary based on interviews with 4 out of 5 residents stated the facility is clean, the 5 residents was not asked questions about facility cleanliness. LPA Mendivil has observed the facility to be clean and sanitary on multiple visits including the annual conducted on 03/27/2025. LPA Mendivil observed 5 residents rooms that were all clean and did not have odors.

It was alleged that residents do not have access to their personal belongings. Based on interviews with 2 out of 5 residents stated they have access to their personal belongings. 3 out of the 5 residents were not asked directly about access to their belongings. Interviews with Executive Director Wendy stated residents have access to their personal items and no complaints from residents about not having access to personal belongings.

Therefore based on preponderance of evidence through interviews and observations the allegations Staff confines resident to bedroom, Staff do not maintain sanitary facility, Staff do not ensure that resident has access to personal belonging 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: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4