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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005403
Report Date: 07/22/2026
Date Signed: 07/22/2026 02:27:52 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
07/15/2026 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20260715164200
FACILITY NAME:ST. ANDREWS HOME FOR THE AGEDFACILITY NUMBER:
306005403
ADMINISTRATOR:VALENCIA, VICTORIAFACILITY TYPE:
740
ADDRESS:8791 ST. ANDREWS AVENUETELEPHONE:
(714) 496-8302
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:6CENSUS: 5DATE:
07/22/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Victoria Valencia - AdministratorTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Facility is forcing resident/client to participate in exercise.
INVESTIGATION FINDINGS:
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On July 22, 2026, Licensing Program Analysts (LPAs) Eboni Bentley and Taylor Simerly conducted an unannounced initial complaint investigation visit into the above allegations. LPAs were greeted and granted entry by staff and met with Administrator Victoria Valencia after explaining the purpose of the visit.

During the visit, LPAs obtained Client/Staff rosters, Emergency and Information Form, Physician’s report, Needs and Service Plan, Individual Program Plan (IPP), Medication Administration Records, and Hospital Records. LPAs also conducted client and staff interviews.

The following was determined during the course of the investigation:
Regarding the allegation, Facility is forcing client to participate in exercise, it was alleged that Staff #1 (S1) forces Client #1 (C1) to walk when client communicates that they do not want to walk.

Continue to LIC9099-C......
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
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 4
Control Number 22-AS-20260715164200
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: ST. ANDREWS HOME FOR THE AGED
FACILITY NUMBER: 306005403
VISIT DATE: 07/22/2026
NARRATIVE
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The Physician’s Report for C1 dated January 6, 2026, indicates that C1 is non-ambulatory, requires assistance with transferring, and is able to communicate needs. The Needs & Service Plan dated November 1, 2025, reports that C1 walks with an unsteady gait, is at risk of falls, and uses a walker but has a difficult time maneuvering it. Two out of three clients interviewed denied the allegation. LPAs were unable to take statements for two clients due to their medical condition and others were out of the facility during the visit. One client initially confirmed the allegation and later denied the same allegation during the interview. Four out of five staff denied the allegation, stating staff do not force clients to exercise if they do not want to. During an interview, S1 confirmed the allegation by admitting they continue to have C1 take 2-3 steps after C1 communicates they do not want to continue trying to walk.

Based on interviews that were conducted and records reviewed during the investigation, the preponderance of evidence standard has been met for allegation: Facility is forcing client to participate in exercise is deemed SUBSTANTIATED. A deficiency is being cited on the attached LIC 9099-D, as per Title 22, Division 6, Chapter of the California Code of Regulations.

An exit interview was conducted with Administrator Victoria Valencia and a copy of this report, LIC9099-D, LIC811, and appeal rights were provided at the end of the visit.
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20260715164200
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: ST. ANDREWS HOME FOR THE AGED
FACILITY NUMBER: 306005403
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2026
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights (a).. each client shall have personal rights which include, but are not limited to, the following:(3) To be free from. humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature... to physical functioning.
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Administrator agrees to read and review the regulation with staff during training, and send LPA Bentley a signed statement of acknowledgement and understanding with training records by end of day on POC due date.
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Based on interview confirmation, facility staff did not comply with the section cited above, which poses a potential risk to clients in care. During interview, S1 admitting they continue to have C1 take 2-3 steps after C1 communicates they do not towant continue trying to walk.
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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.
SUPERVISOR'S NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4
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
07/15/2026 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20260715164200

FACILITY NAME:ST. ANDREWS HOME FOR THE AGEDFACILITY NUMBER:
306005403
ADMINISTRATOR:VALENCIA, VICTORIAFACILITY TYPE:
740
ADDRESS:8791 ST. ANDREWS AVENUETELEPHONE:
(714) 496-8302
CITY:WESTMINSTERSTATE:CAZIP CODE:
92683
CAPACITY:6CENSUS: 5DATE:
07/22/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Victoria Valencia - AdministratorTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Facility is not allowing resident/client to have visitors.
INVESTIGATION FINDINGS:
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Regarding the allegation, Facility is not allowing resident/client to have visitors, it was alleged that staff have stopped a client from having visits. Three out of three clients interviewed denied the allegation, stating clients are allowed always allowed to have visitors. LPAs were unable to take statements for two clients due to their medical condition and others were out of the facility during the visit. Five out of five staff denied the allegation, stating clients are always allowed to have visitors and no visitors have been told they can no longer visit.

Based on the information gathered during the investigation, the Department is unable to ascertain if the above 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, the allegation is deemed Unsubstantiated. An exit interview was conducted with Victoria Valencia, and a copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4