306005226-6-30-2025-22-AS-MSEY-DJ6LRD-20250701085855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005226
Report Date: 06/30/2025
Date Signed: 06/30/2025 09:34:30 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
05/12/2021 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 22-AS-20210512104043

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:	DATE:	06/30/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Not Available		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff did not meet the needs of the resident.
Medication management inadequate.
Resident was not treated with dignity.
Incontinence management was inadequate.
Resident room dirty.
Transportation service inadequate.
Visitation was not provided adequately.
Staff records of vaccine is not accurate.

INVESTIGATION FINDINGS:

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On 06/23/25 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 05/12/21.

Staff did not meet the needs of the resident.

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 allegations 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: 06/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

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 3

Control Number 22-AS-20210512104043

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: 06/30/2025

NARRATIVE

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Several agencies or persons were contacted to include the Director for the Long-term 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 advocate for the resident was contacted and reported that the allegations listed were true; however, supportive documentation was not received.

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

Medication management inadequate.
See above mentioned documentation.

Resident was not treated with dignity.
See above mentioned documentation.

Incontinence management was inadequate.
See above mentioned documentation.

Resident room dirty.
See above mentioned documentation.

Transportation service inadequate.
See above mentioned documentation.

Visitation was not provided adequately.
See above mentioned documentation.

Staff records of vaccine is not accurate.
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.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20210512104043

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: 06/30/2025

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Donna Gurriere, Licensing Program Analyst (LPA) issued this report on 06/30/25 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: 06/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

LIC9099 (FAS) - (06/04)

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