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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 03:50:26 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
06/30/2025 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250630094024
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: 2DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Karen SaturnoTIME COMPLETED:
03:09 PM
ALLEGATION(S):
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Facility did not safeguard clients personal property
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 30, 2025. LPA Haley was greeted by staff and explained the reason for the visit upon entry.

Regarding the allegation: Facility did not safeguard client’s personal property.

During interviews 3 of 3 individuals provided information that supports the complaint allegation above. On May 31, 2025 Client 1’s (C1) electric bike (E-Bike) was stolen from the backyard area of the facility. Police were called and came to the facility to investigate. When police arrived, they spoke to staff and requested to review camera footage from the backyard; however, the camera in the backyard does not work. Staff 1 (S1) and Witness 1(W1) both confirmed the E-Bike was stolen from the facility. S1 confirmed C1 owned an E-Bike, and states C1 was instructed to park the E-Bike in the garage but started parking the E-Bike in the backyard at some point.
Continued on LIC9099C
Substantiated
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 3
Control Number 22-AS-20250630094024
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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Based on the evidence gathered through interviews, document review, and observations, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22.

An exit interview was conducted, and a copy of this report, and appeal rights were 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 3
Control Number 22-AS-20250630094024
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2025
Section Cited
CCR
80026(b)
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(b) If such a client is accepted for or maintained in care, his/her..., personal property, and valuables... shall be handled by the licensee or facility staff, and shall be safeguarded in accordance with the requirements specified… below. This requirement is not being met as evidenced by:
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Administrator Saturno will read and review the regulation section cited above. AD Saturno will send a signed statement of acknowledgement and understanding after the regulation section is reviewed. Finally, the licensee will write out and explain the plan that will be put in place to prevent this from happening again. The written plan of action and the signed statement of acknowledgement and understanding will be emailed to LPA Haley by 12 noon on the POC due date: Monday, July 14, 2025.
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C1’s e-bike was stolen from the backyard of the facility on My 31, 2025. This poses a potential health, safety, and personal rights risk to clients in care.
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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: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

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

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3