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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005768
Report Date: 02/17/2026
Date Signed: 02/17/2026 09:14:17 AM

Unfounded


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
08/28/2023 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230828110941
FACILITY NAME:SAINT AGNES CAREFACILITY NUMBER:
306005768
ADMINISTRATOR:ROSARIO, ROBERTO DELFACILITY TYPE:
740
ADDRESS:4931 CARTHAGE STREETTELEPHONE:
(657) 258-9152
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 6DATE:
02/17/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:JP Vargas- Staff TIME COMPLETED:
09:35 AM
ALLEGATION(S):
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Staff are threatening a resident while in care
Staff behavior poses as a risk to a resident while in care
INVESTIGATION FINDINGS:
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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 Department received the complaint on 08/28/2023 and the initial 10-day visit was conducted on 09/07/2023 by LPA Martinez. LPA Martinez conducted interviews with staff and residents. Regarding the allegations staff are threatening a resident while in care and staff behavior poses as a risk to resident while in care the investigation revealed the following:

It was alleged that staff are threatening Resident 1 ( R1) while in care. Per review of interview with Administrator Lestor Del Rosario conducted by LPA Martinez on 09/07/2023 stated R1 has never resided at Saint Agnes Care.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026
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-20230828110941
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: SAINT AGNES CARE
FACILITY NUMBER: 306005768
VISIT DATE: 02/17/2026
NARRATIVE
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It was alleged that staff behavior poses a risk to resident while in care. Based on interviews conducted on 09/07/2023 by LPA Martinez 5 residents stated staff is good and they have no complaints. Per interviews with current 2 out of 2 staff stated R1 has not resided in the facility and denied any behavior that would pose a risk to residents.

Therefore, based on the preponderance of evidence through interviews the allegations staff are threatening a resident while in care and staff behavior poses a risk to resident while in care are determined to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.



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

DATE: 02/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2