306005195-9-23-2025-22-AS-APAO-DLZP43-20250930105827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005195
Report Date: 09/23/2025
Date Signed: 09/23/2025 03:23:04 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
11/17/2022 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221117153522

FACILITY NAME:	EMBASSY RESIDENTIAL CARE II		FACILITY NUMBER:	306005195
ADMINISTRATOR:	KON, CORA		FACILITY TYPE:	735
ADDRESS:	1621 E SANTA ANA STREET		TELEPHONE:	(714) 732-7217
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92805
CAPACITY:	6	CENSUS: 4	DATE:	09/23/2025
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Cora Kon		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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-Facility staff verbally abused client
-Facility staff inflicted the client with humiliation, ridicule and intimidation of a punitive nature which interfered with the client eating.
-Facility staff does not accord dignity and respect to client in their personal relationship.

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 at the door and granted entry. LPA spoke with Cora Kon, Administrator and explained the purpose of the visit.

Findings are based upon this investigation which included tour of the facility, facility file review, resident file review, interviews conducted and copies of pertinent documents ontained.

It is alleged that facility staff verbally abused client by yelling at them, facility staff inflicted the client with humiliation, ridicule specifically to making fun of client and intimidation of a punitive nature which interfered with the client eating and facility staff does not accord dignity and respect to client in their personal

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)

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Control Number 22-AS-20221117153522

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: EMBASSY RESIDENTIAL CARE II	FACILITY NUMBER: 306005195
	VISIT DATE: 09/23/2025

NARRATIVE

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relationship specifically with staff. Interview with 2 of 2 staff stated that client (C1) has behavior episodes when they don’t get things as they want them or how they want them. Staff try hard to keep clients happy all the time despite of the challenges. Staff have not seen other staff treating clients badly or speak to them bad. Interview with 3 of 4 clients have not seen staff yelling at anyone and there is a roommate that gets upset and yells all the time and is disruptive. Clients stated they like the staff and they have a good relationship with them. They have not seen any of the staff be abusive to anyone, talk badly or make fun of anyone and they treat them very well. Record review revealed that C1’s IPP report stated staff shared C1 tends to go out to eat after his peers have left and then complains the food is cold. Staff shared special meals are prepared for C1 but they will also not eat them at meal time. C1 receives behavior support at Embassy Residential II. C1 is receiving services to target restiveness, inappropriate social behavior, and intimidation of others.

Based on the information mentioned above, the Department is unable to ascertain if the allegation 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, these allegations are 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)

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