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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005195
Report Date: 11/08/2025
Date Signed: 11/08/2025 11:53:00 AM

Substantiated


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
08/28/2023 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230828082343
FACILITY NAME:EMBASSY RESIDENTIAL CARE IIFACILITY NUMBER:
306005195
ADMINISTRATOR:KON, CORAFACILITY TYPE:
735
ADDRESS:1621 E SANTA ANA STREETTELEPHONE:
(714) 732-7217
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:6CENSUS: 4DATE:
11/08/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Direct Support Professional Melanie MirandaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Licensee did not maintain accurate records of client money
INVESTIGATION FINDINGS:
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On Novemeber 8, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to continue the investigation into the above listed allegation 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) Cora Kon was notified via telephone but was unable to assist with today's visit.

The Department received the complaint on August 28, 2023. On today's visit, LPA conducted three staff interviews, conducted two client interviews, and attempted two additional client interviews. LPA also collected pertinent records to the complaint such as the current client roster and client records.

Regarding the allegation that, licensee did not maintain accurate records of client money, the following has been concluded: It was alleged that the facility did not keep a receipt for a full electric bed purchase made on July 8, 2023, for Client #1 (C1), in the amount of $500.00. The Department reviewed the Personal and Incidental (P&I) expense monies for C1. CONTINUED ON LIC9099-C
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2025
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 5
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
08/28/2023 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230828082343

FACILITY NAME:EMBASSY RESIDENTIAL CARE IIFACILITY NUMBER:
306005195
ADMINISTRATOR:KON, CORAFACILITY TYPE:
735
ADDRESS:1621 E SANTA ANA STREETTELEPHONE:
(714) 732-7217
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:6CENSUS: 4DATE:
11/08/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Direct Support Professional Melanie MirandaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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3
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9
Licensee mishandled client money
INVESTIGATION FINDINGS:
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On Novemeber 8, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to continue the investigation into the above listed allegation 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) Cora Kon was notified via telephone but was unable to assist with today's visit.

The Department received the complaint on August 28, 2023. On today's visit, LPA conducted three staff interviews, conducted two client interviews, and attempted two additional client interviews. LPA also collected pertinent records to the complaint such as the current client roster and client records.

Regarding the allegation that, licensee mishandled client money, the following has been concluded: It was alleged that Client #1 (C1) Personal and Incidental (P&I) expense monies were mishandled during a purchase made on July 8, 2023, for a full electric bed, in the amount of $500.00.
CONTINUED ON LIC9099-C
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20230828082343
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: 11/08/2025
NARRATIVE
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During the complaint visit conducted on November 8, 2025, the Department inspected C1's bedroom. The Department observed that there was a full electric bed in C1's bedroom and that the bed was operational and appeared to be in good condition. The Department conducted an interview with C1. C1 stated that it was his idea to buy the new bed and that he has enjoyed the bed since it was purchased in 2023. C1 also confirmed that the bed was brand new when it was purchased. The Department conducted two client interviews for this allegation. Two out of the two clients interviewed denied any issues with the facility mishandling their P&I. The Department conducted four staff interviews. Four out of the four staff interviewed denied client's P&I ever been mishandled.

Based on the evidence gathered during the investigation, 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, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted via telephone with Administrator Cora Kon. A copy of the report was provided to an authorized facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 22-AS-20230828082343
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: 11/08/2025
NARRATIVE
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The Department observed on C1's P&I ledger that a purchase was made on July 8, 2023, for a full electric bed in the amount of $500.00. The Department reviewed the supporting receipts for all purchases made for C1 in July 2023. The Department observed that there was no receipt on file for the full electric bed purchase with details on where the full electric bed was purchased from. The Department conducted four staff interviews. Four out of the four staff interviewed confirmed that there was no receipt on file for the full electric bed purchase made for C1 on July 8, 2023.

Based on the evidence gathered during this investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A deficiency is cited on the attached LIC9099-D. An exit interview was conducted via telephone with Administrator Cora Kon. A copy of the report and Appeal Rights were provided to an authorized facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20230828082343
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/29/2025
Section Cited
CCR
80026(h)(1)
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80026 Safeguards for Cash Resources, Personal Property, and Valuables of resident:
(h) Each licensee shall maintain accurate records of accounts of cash resources..(1) .... Supporting receipts for purchases shall be filed in chronological order.
This requirement is not evidenced by:
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The Administrator stated that they will conduct a training with all staff regarding maintaining receipts for clients Personal and Incidental expense monies. The Administrator agreed to provide LPA proof of the training via email or fax by POC date.
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Based on interviews conducted and records reviewed, the Licensee did not have a receipt on file for a purchase made for Client #1 (C1) on July 8, 2023, for a full electric bed. This poses a potential personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5