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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004839
Report Date: 10/23/2025
Date Signed: 10/23/2025 04:15:20 PM

Unfounded


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
02/07/2024 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20240207092654
FACILITY NAME:FULLERTON VILLAFACILITY NUMBER:
306004839
ADMINISTRATOR:DARLENE LINDLEYFACILITY TYPE:
740
ADDRESS:2441 W. ORANGETHORPE AVE.TELEPHONE:
(714) 992-5380
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:197CENSUS: DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jae Wan RimTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Facility failed to issue a refund after a resident moved out
Facility staff failed to provide a healthful environment, resulting in a resident's hospitalization
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. An initial investigation visit was conducted on February 15, 2024 by the Department.

It was alleged staff facility failed to issue a refund after a resident moved out and facility staff failed to provide a healthful environment, resulting in a resident's hospitalization. During the investigation, the Department conducted interviews with residents in care and staff. LPA Arias reviewed records obtained.

The investigation determined as follows: Regarding the allegation facility failed to issue a refund after a resident moved out, it was reported the facility did not provide a refund when resident 1 (R1) did not return to the facility after being hospitalized on January 3, 2024.
Continued on LIC9099-C dated 10/23/2025
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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-20240207092654
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: FULLERTON VILLA
FACILITY NUMBER: 306004839
VISIT DATE: 10/23/2025
NARRATIVE
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R1's rent was prepaid for the month of January 2024. Per R1's admission agreement signed by R1's responsible person, page 5 states "There will be no refund of any portion of prepaid rent, except in the event of death of the resident..." In addition, page 7 states "The Resident agrees to give the Facility thirty(30) day written notice of the intent to move from the Facility." R1's responsible party notified the facility in writing on January 8, 2024 that R1 would not be returning to the facility and thus not providing a 30 day notice.

Regarding the allegation facility staff failed to provide a healthful environment, resulting in a resident's hospitalization, it was reported the facility is dirty and there is a lack of hygiene. LPA toured the facility grounds including 6 resident rooms, dining areas on both levels, and kitchen. LPA observed the facility to be clean and in good repair. LPA observed the front lobby being mopped during the visit. LPA interviews with seven out of seven residents stated their rooms are cleaned every day. Two out of seven residents added their rooms are deep cleaned once or twice per week. Seven out of seven residents stated their needs are met by staff. LPA interviews with five out of five staff stated resident needs are being met. Four out of five staff added they assist the residents with taking out the trash daily from their rooms. Two out of five staff added they help with cleaning up the dining room after each service. LPA reviewed deep cleaning schedule from December 4,2023 through December 29, 2023 revealing an average of eight rooms being deep cleaned per day.

Based on Department interviews, record review, and observations, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

Exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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
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
02/07/2024 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20240207092654

FACILITY NAME:FULLERTON VILLAFACILITY NUMBER:
306004839
ADMINISTRATOR:DARLENE LINDLEYFACILITY TYPE:
740
ADDRESS:2441 W. ORANGETHORPE AVE.TELEPHONE:
(714) 992-5380
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:197CENSUS: DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jae Wan RimTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not have sufficient staff to ensure adequate care and supervision is provided to the residents in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. An initial investigation visit was conducted on February 15, 2024 by the Department.

It was alleged facility does not have sufficient staff to ensure adequate care and supervision is provided to the residents in care. During the investigation, the Department conducted interviews with residents in care and staff. LPA Arias reviewed records obtained.

The investigation determined as follows: Regarding the allegation facility does not have sufficient staff to ensure adequate care and supervision is provided to the residents in care, it was reported staff took an excessive amount time to respond when the call system was activated. LPA reviewed staff schedules from December 24, 2023 through December 30,2023 and January 14, 2024 through January 20, 2024.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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-20240207092654
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: FULLERTON VILLA
FACILITY NUMBER: 306004839
VISIT DATE: 10/23/2025
NARRATIVE
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32
The schedules revealed an average of ten care giving staff working the day shift, eight care giving staff working the evening shift, and three staff working the NOC shift. In addition, there were two med techs, two nursing staff, and five additional care givers working with higher need residents listed throughout the day and evening shifts. LPA pressed a call button while in a resident room and received an immediate response through the speaker. LPA interviews with six out of seven residents stated staff responds immediately when the call button is pressed. The remaining resident stated there have been a few instances in the early hours of the morning when they have pressed the call button with no response. LPA interviews with five out of five staff stated when a resident presses the call button, the front office is notified and staff is called to check on the resident using a walkie-talkie.

Based on Department interviews, record review, and observations, the allegation is therefore deemed unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4