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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005439
Report Date: 05/15/2026
Date Signed: 05/15/2026 09:27:00 AM

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
11/27/2023 and conducted by Evaluator Hanna Gough
COMPLAINT CONTROL NUMBER: 22-AS-20231127153417
FACILITY NAME:CARE JORDAN SENIOR HOMESFACILITY NUMBER:
306005439
ADMINISTRATOR:GIDEON LIMPIADOFACILITY TYPE:
740
ADDRESS:8728 CANARY AVENUETELEPHONE:
(562) 365-4155
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 6DATE:
05/15/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Sarah Dela Cruz TIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Staff mishandling resident’s medication. -Staff threatened resident. -Staff attempted to hit resident.
Staff did not assist resident in a timely manner. -Staff yelled at resident.
Staff stole money from resident. -Staff handles resident in a rough manner when bathing resident.
Staff not keeping resident’s room free from odor. -Staff left resident on the floor for a long period of time.
Staff made inappropriate comments to resident.
Staff did not provide resident with a copy of the admissions agreement.
Staff does not provide resident with clean linens.
Staff does not properly clean resident
Staff look through resident’s person belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility to conduct an investigation into the above mentioned complaint allegations. LPA was greeted and granted entry by staff. LPA met with House Manager (HM) Sarah Dela Cruz and discussed the purpose of the visit. HM informed Administrator Gideon Limpiado via phone of the purpose of the visit.

The investigation into the above mentioned facility allegations revealed the following:
LPA reviewed the file of Resident #1 (R1) and observed an Admission Agreement signed and dated by R1 and facility staff on August 9, 2022. LPA observed a physicians report dated June 26, 2023, stating that R1 had inappropriate behaviors, able to care for toileting needs with assistance and is nonambulatory due to their physical condition. LPA reviewed 11 incident reports for R1 stating acts of aggression by R1 to staff and residents in care in the year of 2023.
Regarding the facility allegation of staff threatened resident, staff attempted to hit resident, staff yelled at resident, staff handles resident in a rough manner when bathing resident, Staff does not properly clean resident, Staff does not provide resident with clean linens and staff made inappropriate comments to resident revealed the following: Continue on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026
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 3
Control Number 22-AS-20231127153417
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: CARE JORDAN SENIOR HOMES
FACILITY NUMBER: 306005439
VISIT DATE: 05/15/2026
NARRATIVE
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 it was alleged that staff threatened, yelled at and attempted to hit R1 while calling R1 derogatory names. It was also alleged that staff are rough with R1 when giving a shower, do not clean them properly and staff did not change R1s pillowcase for a month. LPA interviewed 2 of 2 staff and the allegations were all denied. 2 of 2 staff informed LPA that R1 would threaten and hit the staff as well as other residents in care. 2 of 2 staff informed LPA that R1 would call the staff and residents names, as well as make inappropriate comments. 1 of 2 staff informed LPA that incident reports were submitted to the Regional Office when the incidents took place regarding R1s behaviors. 2 of 2 staff informed LPA that the linens were changed for all residents in care at least once a week and changed more often if they were soiled.
LPA interviewed 2 residents in care and 1 of 2 residents informed LPA that staff has never hit them, are not rough when providing care, and they assist with their needs such as showers and dressing. 1 of 2 residents did not confirm or deny the allegation but stated the staff are fine.

Regarding the facility allegation of staff not keeping resident’s room free from odor revealed the following: it was alleged that R1 would use the commode in their room and staff would not empty it causing an odor. 2 of 2 staff informed LPA that the commode would be emptied and cleaned every time it was used. 2 of 2 staff informed LPA that sometimes R1 would be asked to wait until staff are done assisting another resident and R1 would become agitated that they did not come immediately.

LPA did not smell an odor during the investigation in the facility.

Regarding the facility allegation of staff left resident on the floor for a long period of time and staff did not assist resident in a timely manner revealed the following: it was alleged that R1 was left on the floor by staff for 8 hours. 2 of 2 staff informed LPA that they would never have left R1 on the floor for any length of time and was assisted immediately if they were observed on the ground or called for help. 1 of 2 residents informed LPA that the staff assist them with all their care needs.

LPA did not review any incident reports regarding R1 being found on the floor by staff.

Regarding the facility allegation of staff did not provide resident with a copy of the admission agreement revealed the following: LPA reviewed an admission agreement for R1 dated August 9, 2022, that was signed by R1 and facility staff. 1 of 2 staff informed LPA that they could not recall if they provided R1 with the admission agreement at the time of their admission, but provided the agreement when R1 requested a copy at a later time.

Continue on LIC9099C

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20231127153417
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: CARE JORDAN SENIOR HOMES
FACILITY NUMBER: 306005439
VISIT DATE: 05/15/2026
NARRATIVE
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1 of 2 staff informed LPA that they do not have documentation of providing the admission agreement to R1 at either time. 1 of 2 staff informed LPA that R1 received their admission agreement at the time of admission and when requested again after residing at the facility for some time.

Regarding the facility allegation of staff look through resident’s personal belongings and staff stole money from resident revealed the following: it was alleged that staff go into R1s room and looks through R1s personal belongings. LPA reviewed a physicians report dated June 26, 2023, that R1 was confused at times. 2 of 2 staff informed LPA that they do not go through R1s belongings but moved things around in order to clean and dust. 1 of 2 staff informed LPA that the facility did not handle or have access to R1s money and that R1 owed the facility money. 1 of 2 staff informed LPA that they would see the money in R1s room but they would not touch it.

Regarding the facility allegation of staff mishandling resident’s medication revealed the following: It was alleged that staff did not administer R1s medication when prompted by R1. LPA reviewed a physicians report dated June 26, 2023, that states that R1 was not able to administer their own medications, but was able to communicate their needs. 2 of 2 staff informed LPA that R1 would take their pain medication and then demand another dose before the prescribed amount of time had elapsed. 2 of 2 staff informed LPA that staff would deny R1 a requested dose when it fell too close to the previously given dosage due to following doctors orders on the prescription label.

LPA was unable to interview R1 regarding the mentioned above complaint allegations.

LPA reviewed staff files and observed 2 of 2 staff have updated training on abuse and neglect in the elder care setting along with housekeeping, behavioral management, medication management resident rights and ADL management training.

Based on information gathered and interviews conducted, the Department is unable to ascertain if the above allegations 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 violations occurred; therefore, the allegations are deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was left at the facility.

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3