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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005226
Report Date: 06/16/2025
Date Signed: 06/17/2025 11:10:20 AM

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
03/01/2021 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 22-AS-20210301092948
FACILITY NAME:ARBOR PALMS OF ANAHEIMFACILITY NUMBER:
306005226
ADMINISTRATOR:NANCY RODRIGEZFACILITY TYPE:
740
ADDRESS:3411 W BALL RDTELEPHONE:
(714) 821-9660
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:0CENSUS: 0DATE:
06/16/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Facility ClosedTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Resident sustained multiple falls while in care.
INVESTIGATION FINDINGS:
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On 06/16/25 Donna Gurriere, Licensing Program Analyst attempted to contact the licensee; however, the facility had a change of ownership and was closed on 02/29/24. The purpose of the telephone call was to discuss a complaint that was received on 03/01/21.

Resident sustained multiple falls while in care.

A new facility, Anaheim Villa, became licensed on 03/01/24. The administrator was contacted; however, was not available; she has been working at the previous and new facility since 2023. The assistant administrator was contacted and reported that she has been working at the previous and new facility since 2022. The assistant administrator was not familiar with the complaint allegation and reported that the resident mentioned was no longer at the facility.
continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
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-20210301092948
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: ARBOR PALMS OF ANAHEIM
FACILITY NUMBER: 306005226
VISIT DATE: 06/16/2025
NARRATIVE
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Several agencies or persons were contacted to include the Director for the Longterm Care Ombudsman’s office, and she reported that the volunteer Ombudsman for Arbor Palms of Anaheim no longer volunteers and that they do not have any open complaints from 2021. The resident’s (Resident 1) family member was contacted, and she reported that the resident did have multiple falls while in care at the facility and that she spoke to the administrator at the time regarding the falls. The family member reported that the resident is now deceased.

There is not enough information to support the allegation of the resident sustaining multiple falls while in care. Therefore, in this matter the allegation is unsubstantiated.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.

Donna Gurriere, Licensing Program Analyst (LPA) issued this report on 06/16/25 to follow up on an Unsubstantiated allegation of a complaint investigation. The facility closed on 02/29/24.

A copy of this report will be sent via certified mail to the last known address of the licensee. If possible, the licensee is to sign and return a copy to the Orange County Regional Office.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2