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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005533
Report Date: 03/07/2022
Date Signed: 03/07/2022 02:38:31 PM



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
03/03/2022 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220303150114
FACILITY NAME:MESA DEL MAR ELDERLY CARE HOMEFACILITY NUMBER:
306005533
ADMINISTRATOR:MARY JEAN CATACUTANFACILITY TYPE:
740
ADDRESS:1097 CORONA LNTELEPHONE:
(657) 210-4719
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:6CENSUS: 5DATE:
03/07/2022
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Mary Jean CatacutanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
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9
Unlawful Eviction
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Joseph Alejandre and Jessica Cho made an unannounced visit to conduct the 10 day visit to begin the investigation into the allegation listed above. LPAs were greeted and granted entry. LPAs explained the reason for the visit. LPAs met the facility Administrator Mary Jean Catacutan. The investigation into the allegation revealed the following; Resident 1 (R1) is currently residing at the facility and has a valid admission agreement. LPAs interviewed the Administrator. Administrator reported that no eviction notices have been given to any residents. There is no record of any eviction requests from the facility to the Agency (CCL). It was alleged that R1 was being unlawfully evicted. No proof has been provided to support the allegation. A review of records and emails show the Administrator informed R1's responsible party that if they were unhappy with the facility they could always give 30 days notice and move R1 out. This information was verified by R1's responsible party (RP) who also verified they have not been served and eviction notice. LPAs verified the Administrator was aware of the proper eviction procedure. There is no evidence to support the allegation.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
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-20220303150114
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: MESA DEL MAR ELDERLY CARE HOME
FACILITY NUMBER: 306005533
VISIT DATE: 03/07/2022
NARRATIVE
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 Based on the evidence gathered through record review and interviews the allegation is deemed Unfounded meaning the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2