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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005835
Report Date: 06/12/2026
Date Signed: 06/12/2026 02:59:58 PM

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
02/01/2022 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 22-AS-20220201143127
FACILITY NAME:KIRKWOOD ORANGEFACILITY NUMBER:
306005835
ADMINISTRATOR:ZEHRA, SYEDFACILITY TYPE:
740
ADDRESS:1525 E TAFT AVENUETELEPHONE:
(714) 282-1409
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY:66CENSUS: DATE:
06/12/2026
UNANNOUNCEDTIME BEGAN:
02:57 PM
MET WITH:Erin Palposi- Executive DirectorTIME COMPLETED:
02:58 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not meeting resident's toileting needs
Staff are not feeding resident's in a timely manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On June 12, 2026, Licensing Program Analyst (LPA) Hiratsuka, contacted the facility via phone and email to deliver final findings regarding a complaint that was received on 02/01/2022. The time frame of the allegations is prior to the complaint received by the department

Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegations listed above. Therefore, the allegations above are
unsubstantiated.

A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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