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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005316
Report Date: 07/24/2025
Date Signed: 07/24/2025 02:29:12 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
10/06/2021 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211006143415
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: 138DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Jerry PerezTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Resident was left in soiled clothing for an extended period of time
Facility staff did not respond to the resident's call cord in a timely manner
Facility staff do not offer snacks between meals
Facility staff is not providing a good quality of food
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to investigation the above identified complaint allegation. LPA arrived at facility and was greeted at the door and granted entry receptionist. LPA spoke with Jerry Perez, Administrator, and explained the purpose of the visit.

Findings are based upon this investigation which included resident/facility file review, and interviews conducted.

It is alleged residents are left in soiled clothing for extended period of time. Interviews with staff stated that resident (R1) refuses to have staff change their clothes or diapers. Records review revealed that facility notes from March 2020 to September 2021 R1 refused to be changed clothing and/or diaper from staff.

Continue on LIC9099
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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-20211006143415
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: ANAHEIM CROWN PLAZA
FACILITY NUMBER: 306005316
VISIT DATE: 07/24/2025
NARRATIVE
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On some occasions it reflects refusal by R1 on multiple times throughout the day.

It is alleged that facility staff did not respond to the resident’s call cord in a timely manner. Interview with staff stated that when a resident pulls the cord, there is a beep that goes off throughout building, staff carry radios. As a secondary to the notification on the radio. If there is a Staff who is closed to the main notification in the receptionist area they send a message through radio or through intercom and they will respond to call. Staff have never taken more than 5-10 minutes to respond. Interview with 9 of 9 residents stated that they have never had issues with the pull cord and staff do not take long to respond. They have waited anywhere from 2-15 minutes.

It is alleged facility staff do not offer snacks between meals. Interview with staff stated that residents get snacks, facility has a vending machine and there is a box of snack in the front reception office for residents use. Interview with 9 of 9 residents stated that they get snacks every day, there is a vending machine on the 3rd floor and there is a snack box in the office for them to have as alternatives for all residents.
It is alleged facility is not providing good quality food. LPA toured the facility kitchen, and it was observed that there was sufficient amount of quality and quantity of perishable and nonperishable food for residents. LPA observed food being prepped and staff preparing the food for the residents. In addition, LPA obtained a copy of the facility weekly menu for review with meal options. Interviews with 9 of 9 residents stated that they didn’t have an issue with the food served and the food was good and/or great. A resident stated food is very soft melts in your mouth and not in your hand, which is really good because many seniors cannot eat hard food.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations 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 the Administrator and a copy of this LIC9099 report was left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2