306005293-7-15-2025-22-AS-APAO-DJU7FQ-20250722213755

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005293
Report Date: 07/15/2025
Date Signed: 07/15/2025 04:41:50 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
12/22/2022 and conducted by Evaluator Celine Rodriguez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221222143848

FACILITY NAME:	SANDY CREEK CARE HOME		FACILITY NUMBER:	306005293
ADMINISTRATOR:	MEJIA, JONALYN		FACILITY TYPE:	740
ADDRESS:	26442 SANDY CREEK		TELEPHONE:	(949) 273-3799
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	6	CENSUS: 5	DATE:	07/15/2025
		UNANNOUNCED	TIME BEGAN:	03:21 PM
MET WITH:	Facility Administrators - Jonalyn Mejia & Wilma Fuentes		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff is repeatedly yelling at resident
Facility is not following Physical Therapy orders resulting in worsening of pressure ulcer.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced continuation visit to the facility for the complaint and to deliver the findings. LPA Rodriguez explained the purpose of today's visit, was greeted by staff on duty, and met with Facility Administrators (AD) Jonalyn Mejia & Wilma Fuentes.

During the investigation, LPA De Perio toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed.

It was alleged that staff is repeatedly yelling at resident. LPA Rodriguez conducted a total of 5 interviews that consisted of residents and staff, of which all 5 interviews did not corroborate with the allegation. Interviews with residents described staff as "nice", and denied of ever being yelled at, and denied of observing staff yell at residents. Per record review, staff are trained on how to care for residents, along with resident rights. Upon entering the facility, LPA observed staff engaging in activities with residents in the living room, and that residents were observed to be happy.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025

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-20221222143848

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: SANDY CREEK CARE HOME	FACILITY NUMBER: 306005293
	VISIT DATE: 07/15/2025

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

It was alleged that facility is not following Physical Therapy orders resulting in worsening of pressure ulcer. LPA Rodriguez conducted a total of 5 interviews that consisted of residents and staff, of which all 5 interviews did not corroborate with the allegation. Per interviews and record review, resident 1 (R1) was admitted to facility, after getting discharged from the hospital due to a hip fracture that was sustained. During the investigation, an interview was conducted with R1's responsible party, and it was revealed that although R1 had redness and soreness on R1's tailbone, there was never an instance where R1 had a pressure ulcer. In addition, there were no documents presented from the facility, the hospital, and from home health that R1 ever had a pressure ulcer.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted with AD Mejia and AD Fuentes.

A copy of this report was provided and explained.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2