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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004839
Report Date: 02/18/2026
Date Signed: 02/18/2026 03:19:33 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
02/13/2026 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260213155556
FACILITY NAME:FULLERTON VILLAFACILITY NUMBER:
306004839
ADMINISTRATOR:JAE WAN RIMFACILITY TYPE:
740
ADDRESS:2441 W. ORANGETHORPE AVE.TELEPHONE:
(714) 992-5380
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:197CENSUS: 168DATE:
02/18/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Jae Wan RimTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff administered medication to a resident without proper consent
INVESTIGATION FINDINGS:
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On February 18, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to initiate the investigation into the allegation listed above and to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Jae Wan Rim was present and assisted on today's visit.

During the course of the investigation, LPA conducted one staff interview, reviewed and obtained pertinent documents to the complaint. Regarding the allegation, staff administered medication to a resident without proper consent, the following has been concluded: It was alleged that staff administered medication to Resident #1 (R1) without proper consent. LPA reviewed R1's file including the admission agreement, medical assessment, pre-placement appraisal, resident appraisal, needs and services plan, and medication administration records. LPA observed there was no medical power of attorney on file for R1, or any other document in which the facility was required to obtain consent from R1's responsible party prior to administrating medication to R1. CONTINUED ON LIC9099-C
Unfounded
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
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-20260213155556
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: 02/18/2026
NARRATIVE
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LPA observed that the facility was administering medication to R1 in accordance with her prescribed medication orders, as per regulations. There is also no regulations that requires the facility to obtain consent from a resident's responsible party prior to administering their prescribed medications. LPA conducted one staff interview. The staff interviewed confirmed that R1 did not have a medical power of attorney and that medications were administered in accordance to R1's prescribed orders.

Based on the evidence gathered during this investigation, the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. An exit interview was conducted Administrator Jae Wan Rim and a copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2