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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005316
Report Date: 06/16/2026
Date Signed: 06/16/2026 11:26:38 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/23/2022 and conducted by Evaluator Avelina Martinez
COMPLAINT CONTROL NUMBER: 22-AS-20220923085113
FACILITY NAME:ANAHEIM CROWN PLAZAFACILITY NUMBER:
306005316
ADMINISTRATOR:JOHNSON, CAMMYFACILITY TYPE:
740
ADDRESS:641 SOUTH BEACH BLVDTELEPHONE:
(714) 827-7007
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:200CENSUS: DATE:
06/16/2026
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff stole residents medication(s).
Staff are mismanaging resident's medication(s).
Staff are not administering resident's medications according to their physician.
Staff are falsifying resident(s) medical documentation.
INVESTIGATION FINDINGS:
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On June 16, 2026 at 11:20 AM, Licensing Program Analyst (LPA) Avelina Martinez conducted a Microsoft Teams meeting with the facility designated administrator for the purpose of delivering complaint findings for the above allegations.

During this investigation, LPA Martinez reviewed facility records and conducted interviews. When interviewed, resident 1 (R1) reported that they did not know if their medication was stolen by staff. R1 reported that they were informed that their medication was running low by a staff member. However, the medication was refilled prior to running out. R1 reported their medicaiton was admistered to them as needed. R1 reported they currently have no issues or concerns with their medication. In addition, R1's August and September 2022 medication administration records did not have any discrepencies.

Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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-20220923085113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: ANAHEIM CROWN PLAZA
FACILITY NUMBER: 306005316
VISIT DATE: 06/16/2026
NARRATIVE
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Due to the above noted information, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2