306005207-1-28-2026-22-AS-APAO-DR87BX-20260211203152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005207
Report Date: 01/28/2026
Date Signed: 01/28/2026 02:51:55 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
05/22/2024 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20240522120534

FACILITY NAME:	HARVEST RETIREMENT		FACILITY NUMBER:	306005207
ADMINISTRATOR:	GINGER PO		FACILITY TYPE:	740
ADDRESS:	9011 KNOTT AVE		TELEPHONE:	(714) 821-4130
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	106	CENSUS: 73	DATE:	01/28/2026
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Rose Enriquez, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff handled resident in a rough manner causing a skin tear
Staff locked the resident's door preventing the POA from seeing the resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to follow-up on a complaint received in the Regional Office. LPA was greeted and granted entry and met with Administrator (AD) Rose Enriquez at 1:15pm, and explained the purpose of the visit.

LPA obtained the following documents: Facility in-services on Body Mechanics, Transfers, Assists from June 22, 2023, and an in-service provided by Evergreen Hospice Nurse on April 10. 2024. LPA reviewed Resident #1 (R1)'s: Identification and Emergency Information Form, Physician's Report, and Death Report. LPA also obtained hospice documentation for care provided from May 13-24, 2024. R1 passed away on May 21, 2024.

(Continued on LIC 9099-C)

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026

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-20240522120534

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: HARVEST RETIREMENT	FACILITY NUMBER: 306005207
	VISIT DATE: 01/28/2026

NARRATIVE

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(Continued from LIC 9099)

It was alleged that Staff handled resident in a rough manner causing a skin tear. LPA reviewed hospice documents, dated May 18-19, 2024, regarding Resident #1 (R1)'s hospice care provided. A skin tear was documented on R1's left wrist. It was reported to the hospice that Staff handled resident in a rough manner causing a skin tear. Hospice could not confirm nor deny statement and provided wound care to R1. R1 was non-responsive at this time. LPA interviewed two of two witnesses. Two of two witnesses could not confirm, nor deny the allegation. LPA interviewed three of three staff regarding the above allegation and three of three staff denied the allegation.

LPA investigated the allegation that Staff locked the resident's door preventing the POA from seeing the resident. LPA interviewed two of two witnesses. Two of two witnesse could not confirm, nor deny the allegation. Three of three staff members were interviewed. Three of three staff members denied the allegation. R1 was a two person assist and that staff, as well as hospice, would close the door for privacy but stated the door was never locked. Resident #1 (R1) was actively passing during this time and staff, POA and visitors were not denied entry. LPA was unable to interview the person who stated the doors were locked and denied entry.

Based on LPA's record review and interviews, the allegations that: Staff handled resident in a rough manner causing a skin tear and Staff locked the resident's door preventing the POA from seeing the resident are Unfounded. The allegations are false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted with Administrator (AD) Rose Enriquez, and a copy of this report and LIC 811 were provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026

LIC9099 (FAS) - (06/04)

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