306005226-6-17-2025-22-AS-MSEY-DHXSYC-20250624141719

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005226
Report Date: 06/17/2025
Date Signed: 06/17/2025 01:46:41 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
04/15/2021 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 22-AS-20210415110656

FACILITY NAME:	ARBOR PALMS OF ANAHEIM		FACILITY NUMBER:	306005226
ADMINISTRATOR:	NANCY RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	3411 W BALL RD		TELEPHONE:	(714) 821-9660
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	0	CENSUS: 0	DATE:	06/17/2025
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	No administrator, closed facility		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff pinched resident sustaining in bruising.
Resident sustained unexplained bruises.
Resident's hygiene needs are not being met.
Resident's diapering needs are not being met.
Facility did not provide resident's records to resident's responsible party.

INVESTIGATION FINDINGS:

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On 06/17/25 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 04/15/21.

Staff pinched resident sustaining in bruising.

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 Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

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-20210415110656

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: 06/17/2025

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. An attempted telephone call was made to the resident’s (Resident 1) family member; however, on numerous occasions the recording stated, “The call could not be completed.”

There is not enough information to support the allegation mentioned above; therefore, in this matter the allegation is unsubstantiated.

Resident sustained unexplained bruises.
See above mentioned documentation.

Resident's hygiene needs are not being met.
See above mentioned documentation.

Resident's diapering needs are not being met.
See above mentioned documentation.

Facility did not provide resident's records to resident's responsible party.
See above mentioned documentation.

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

Donna Gurriere, Licensing Program Analyst (LPA) issued this report on 06/17/25 to follow up on unsubstantiated allegations 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 Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2025

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)

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