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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004839
Report Date: 09/23/2025
Date Signed: 09/23/2025 12:30:36 PM

Unsubstantiated


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
07/12/2022 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220712101114
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: 152DATE:
09/23/2025
UNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Jae Wan Rim, AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff not responding to resident's calls
Staff not providing assistance to resident when brushing teeth
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation to the above identified complaint allegations. LPA arrived at the facility and was greeted and granted entry. LPA spoke with Jae Wan Rim, Administrator and explained the purpose of the visit.

Findings are based upon this investigation which included tour of the facility, facility file review, and interviews conducted.

It is alleged that staff not responding to residents’ calls. Interviews with 10 of 10 residents stated that when they call for help, they have always gotten the help they need, and staff come to help them all the time. They stated that they have waited about 10-15 minutes at a time, but they have not waited too long. Interview with staff stated that they get the call and the caregiver that is assigned to that area of the facility
Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
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 2
Control Number 22-AS-20220712101114
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: 09/23/2025
NARRATIVE
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answers the call. LPA Lydia Martinez conducted a tour of the facility on July 19, 2022, and observed caregivers on the floor getting calls for assistance and answering those call and assisting residents.

It is alleged that staff not providing assistance to residents when brushing teeth. Interview with 3 of 3 staff stated that they help resident (R1) with their brushing needs. Teeth were brushed after every meal or at a minimum 3 times a day. Staff stated that when they would brush R1’s teeth that they never observed any blood coming from their gums. R1 would get combative at time and staff would assist in calming them down and try to brush their teeth again. They would not force R1 to brush their teeth because they know resident have rights to refuse. Interview with 10 of 10 residents stated that they have observed staff helping other residents when they need help.

Based on the information mentioned above, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted with the Administrator and a copy of this LIC9099 report was left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2