<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005513
Report Date: 07/28/2026
Date Signed: 07/28/2026 11:06:00 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/30/2026 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260330161235
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: 180DATE:
07/28/2026
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Mandy Taylor - Executive Director TIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Faciltiy is charging for services not provided
Faciltiy does not ensure resident is changed timely resulting in multiple UTIs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit.

The Deparmtent received the complaint on March 30th, 2026 and the initial 10 day visit was conducted on April 09th, 2026. LPA Mendivil obtained copies of : admission agreement, physician's report, and needs and services, and staff schedules. LPA Mendivil interviewed staff and residents. Regarding the allegations facility is charging for services not provided and facility does not ensure resident is changed timely resulting in multiple UTIs, the investigation revealed the following:

It is alleged that the facility is charging for services not provided.Per interviews with 4 out of 4 staff, staff stated that everyday assistance with Activities of Daily Living (ADLs) are not documented , this would include repositioning or checking on resident. Per Resident Care Coordinator Ruby Molina only exceptions are documented for care, meaning only out of the norm items are documented.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
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 2
Control Number 22-AS-20260330161235
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CARMEL VILLAGE RETIREMENT COMMUNITY
FACILITY NUMBER: 306005513
VISIT DATE: 07/28/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Staff stated that a resident that needs repositioning is repositioned every 2-3 hours. Interviews with 6 residents with varying levels of care needed all stated that the staff is providing the care they need and pay for. 6 out of 6 residents stated the staff is wonderful and helpful.

It was alleged that facility does not ensure resident is changed timely resulting in multiple UTIs. Per interviews with 4 out of 4 staff, staff denies leaving any resident in soiled diapers for an extended period of time. Interviews with 6 residents, residents stated that staff is responsive and have not left them for extended periods of time.

Therefore based on the preponderance of evidence through records reviewed and interviews the allegations facility is charging for services not provided and facility does not ensure resident is changed timely resulting in multiple UTIs is determined to be UNSUBSTANTIATED, meaning that although the alleged violation may have happened or is valid there is not a preponderance of evidence to prove the alleged violation occurred.

An exit was conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2