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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005513
Report Date: 01/26/2026
Date Signed: 01/26/2026 03:26:13 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
01/16/2026 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20260116091806
FACILITY NAME:CARMEL VILLAGE RETIREMENT COMMUNITYFACILITY NUMBER:
306005513
ADMINISTRATOR:MANDY TAYLORFACILITY TYPE:
740
ADDRESS:17077 SAN MATEOTELEPHONE:
(714) 962-6667
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:220CENSUS: 183DATE:
01/26/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Mandy Taylor - Executive DirectorTIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Facility is in disrepair.
INVESTIGATION FINDINGS:
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On January 26, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for a initial complaint investigation visit into the above allegation. LPA was greeted and granted entry after stating the purpose of the visit to staff. Executive Director Mandy Taylor arrived shortly and assisted with the visit.

LPA reviewed facility documents including: Resident Roster, Staff Roster, Staff Contacts, Staff Schedule, Resident Emergency Info & Contact Sheet, Physician's Report, Service Plans, and admission agreements. Interviews were conducted with residents, staff, and witnesses.

Regarding the allegation: Facility is in disrepair
It is alleged that the facility ceilings leak when it rains, staff uses buckets to catch the water, and repairs to leaks have not been made.

CONTINUE TO LICE9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
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-20260116091806
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: CARMEL VILLAGE RETIREMENT COMMUNITY
FACILITY NUMBER: 306005513
VISIT DATE: 01/26/2026
NARRATIVE
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During the visit, LPA Bentley toured the interior and exterior of the facility with staff. Observations were made and photos were taken of water damage to ceiling panels in the hallways and in resident bedrooms. LPA observed a ceiling panel in the hallway where a leak was reported. Four out of five staff interviewed confirmed the allegation, stating the area leaked during a recent rain in December 2025 and a bucket was used to catch the water. One staff stated leaks were first discovered in December 2024, recurred in December 2025, and have not been repaired. A record review confirmed repairs had not been done to repairs the leak.

Based on the evidence gathered through interviews and observations, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. A deficiency is being cited per California Code of Regulations Title 22.

An exit interview was conducted Executive Director Mandy Taylor, and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260116091806
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: CARMEL VILLAGE RETIREMENT COMMUNITY
FACILITY NUMBER: 306005513
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2026
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provisions of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
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Executive Director stated the entitre third floor roof will be inspected by a professional vendor and repaired by POC due date with proof submitted to CCLD by POC due date via email.
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Based on observation and interviews conducted, the licensee did not comply with the section cited above, which poses a potential health and safety or risk to persons in care. LPA observed water stains on ceiling panels of Building 2, third floor where leaks were resported. Interviews confirmed water damage occurred due to rain between Dec 2024 and Dec 2025 with no record that repairs had not been made.
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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: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
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