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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005644
Report Date: 07/08/2025
Date Signed: 07/08/2025 08:22:58 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
06/20/2025 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250620102807
FACILITY NAME:NOUMEA CARE HOME IIIFACILITY NUMBER:
306005644
ADMINISTRATOR:SANTOS, MELBAFACILITY TYPE:
735
ADDRESS:6356 SHERMAN WAYTELEPHONE:
(714) 788-9165
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:4CENSUS: 3DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
07:35 AM
MET WITH:Karen SaturnoTIME COMPLETED:
08:35 AM
ALLEGATION(S):
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Facility staff threaten a client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to begin the investigation into the complaint received June 20, 2025. LPA Haley was greeted by staff and explained the reason for the visit upon entry.

Regarding the allegation: Facility staff threaten a client

During the investigation 5 of 6 individuals were unable to provide any information that would support or corroborate the complaint allegation above. During interviews, Client 1 (C1) admitted no one heard the staff member make a threatening comment to the client because the conversation was over the phone. C1 says no one was around when the comment was made. Staff members interviewed denied hearing any threatening comments being made to any of the clients. Interviews with a witness, a facility staff member, and document review reveal when C1 doesn’t get their way, C1 will tend to get upset.

Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
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-20250620102807
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: NOUMEA CARE HOME III
FACILITY NUMBER: 306005644
VISIT DATE: 07/08/2025
NARRATIVE
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According to witness 1 (W1), C1 takes things out of context and has a history of playing the role of a victim when C1 gets upset. A review of C1’s Individual Program Plan (IPP) reveals when extremely upset, overly anxious, or when unable to control others and/or situations around them, C1 is known to be non-compliant and verbally aggressive.

Based on the information gathered during the investigation through interviews and observations, the Department is unable to ascertain if the 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, and a copy of this report was provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2