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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005316
Report Date: 10/14/2025
Date Signed: 10/14/2025 03:51:05 PM

Substantiated


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
10/06/2025 and conducted by Evaluator Hanna Gough
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251006160722
FACILITY NAME:ANAHEIM CROWN PLAZAFACILITY NUMBER:
306005316
ADMINISTRATOR:GERARDO RODRIGUEZFACILITY TYPE:
740
ADDRESS:641 SOUTH BEACH BLVDTELEPHONE:
(714) 827-7007
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:200CENSUS: 147DATE:
10/14/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Gerardo RodriguezTIME COMPLETED:
04:05 PM
ALLEGATION(S):
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Staff does not ensure facility is free of bed bugs.
Staff did not seek timely medical attention for resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hanna Gough arrived at the facility for the purpose of investigating the above mentioned allegations. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Gerardo Rodriguez and discussed the purpose of the visit.

The investigation into the allegations of Staff does not ensure facility is free of bed bugs and Staff did not seek timely medical attention for resident revealed the following: During the course of the investigation LPA observed Resident 1 (R1) was admitted to the facility on June 10, 2024. LPA observed a physicians report for R1 dated May 13th, 2025, stating that R1 has bladder impairment, motor impairment, is not able to dress themselves and is non ambulatory due to their physical condition. LPA observed a needs and services plan that was signed and dated August 29th, 2025 by facility staff and R1s responsible party stating that R1 needs assistance with ADLs including incontinence care, grooming, and dressing in which facility staff are responsible for implementation.
Continue on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
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-20251006160722
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: 10/14/2025
NARRATIVE
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. LPA observed an incident report dated October 6, 2025, stating that R1 was sent to the hospital on October 4, 2025, due to weakness and feeling sleepy. LPA observed a physicians order for a urinary analysis sample to be done for R1 on September 30, 2025.

Interviews with staff 2 of 4 staff revealed that R1 had bed bugs in their room that were treated by facility staff. 2 of 4 staff revealed that they did not call a pest control company, but took care of the problem internally. 2 of 4 staff revealed that to their knowledge the facility is free of bedbugs at the time of the investigation. 1 of 4 staff informed LPA that another room previously had bedbugs about a month ago that has since been eradicated.

LPA toured the facility with staff and observed R1s room had no bedbugs on the bed or wheelchair. LPA observed an insect with Staff 1 (S1) that was found in R1s closet. LPA observed R1s room to be cleaned and given a new mattress that is in a mattress cover.

Interviews with 4 of 4 staff revealed that R1 was in the hospital at the time of the investigation. 3 of 4 staff informed LPA that R1 was sent to the hospital on October 4, 2025, due to an UTI suspicion. 3 of 4 staff informed LPA that on September 30, 2025, it was brought to staffs attention that R1 had a foul smell in their urine. Facility staff called R1s responsible party and physician. 3 of 4 staff informed LPA that R1 was delayed getting a sample due to R1 refusing to provide a urine sample and then once obtained the sample expired before it could be sent to the lab for testing. 3 of 4 staff informed LPA that R1s responsible party requested for R1 to go to the hospital due to it being days since suspicion and nothing had been accomplished.

Based on observation, interviews, record review and information gathered during the investigation, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22 Division 6 are being cited on the attached LIC9099D.

An exit interview was conducted with AD and a copy of this report, LIC9099D and appeal rights were left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20251006160722
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/15/2025
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times...

This requirement was not met as evidence by:
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Administrator stated that they will do an in service for staff regarding bedbugs and schedule a pest control company to come for inspection and treatment if necessary and send proof of confirmation date to LPA by POC due date. AD will send LPA reports upon completion.
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LPA observed a bug in R1s closet and 2 of 4 staff informed LPA that R1s room had bedbugs that they had to treat. This poses an immediate health safety and personal rights risk to residents in care.
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Type A
10/15/2025
Section Cited
CCR
87465(a)(2)
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87465(a)(2) Incidental Medical and Dental Care The licensee shall provide assistance in meeting necessary medical... needs....
This requirement was not met as evidence by:
3 of 4 staff informed LPA that R1 was
suspected with a UTI on September 30,
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Administrator stated they will do an in service with staff regarding symptoms of a UTI, when to call 9-11 and what to do if a resident refuses to be sent out or give samples for lab testing and send proof to LPA by POC due date.
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 2025 and was taken to the hospital only after R1s responsible party requested it on October 4, 2025 after attempting to send a urinary sample to a lab for testing.
This poses an immediate health, safety or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3