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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005835
Report Date: 06/16/2026
Date Signed: 06/16/2026 03:26:40 PM

Unsubstantiated


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
02/25/2026 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260225091435
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: 48DATE:
06/16/2026
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Erin Palposi - Executive Director TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff do not do proper reassessments before a level change
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 and explained the reason for the visit.

The Department received a complaint on Feburary 25, 2026 and the initial 10 day visit was conducted on Feburary 27,2026. LPA Mendivil obtained copies of records including assessments, physician's reports, admission agreements, emails regarding rate change and email correspondence. LPA Mendivil interviewed staff and residents. Regarding the allegation Staff do not do proper reassessments before a level change the investigation revealed the following:

It was alleged that the staff do not do a proper assessments before a level change. It was alleged that Resident 1 (R1) had a change of condition due to behaviors such as rearranging their furniture and wandering which resulted in a higher level of care needed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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-20260225091435
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: KIRKWOOD ORANGE
FACILITY NUMBER: 306005835
VISIT DATE: 06/16/2026
NARRATIVE
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Per interviews with Current Executive Director Erin Palposi, Erin stated that there was a new care assessment tool, August, which went into effect on January 1st, 2026. Erin provided an email sent to families on October 2, 2025 regarding the rate structure change which would take effect on Jan 1, 2026. Per the email it was notated that care levels have changed and provided a new rate and level structure.

Per review of R1's Resident Assessment dated on September 08, 2025 R1 was at a total of 52 points which placed R1 at Level 1 of care. On September 29, 2025 R1 was reassessed to be at a Level 2 with 96 points. Both assessments were conducted with AL Advantage which resulted in lower levels of care reflected. Per review of August assessment dated September 29th, 2025, R1 was assessed at a Level 4 with 133 points due moderate help needed for cognitive/orientation, stating "Resident constantly rearranges personal belongings and furniture... requiring constant re-arranging and redirection" Per review of email sent on September 29. 2025 to R1's responsible party the new assessments and points were provided to R1's responsible party. Based on interviews with staff, residents were not charged for the new level of care based on August assessments until Jan 1st 2026. Per review of billing for R1 there were credits added to R1's account to reduce care rate to reflect the lower level of care payment until January 1, 2026.
Per ED R1 had an episode of wandering outside of the facility in early February 2026, ED stated that R1 was in the front of the building with the front desk staff and did not leave from staff's side. ED stated that she went to assist with the resident and redirect R1 back into the facility. Per ED it had been reported that R1 had previously tried to exit the facility. ED stated they called R1's responsible party and informed them of R1's attempt to exit. Per review of email from ED to R1's responsible party it was explained that due to R1's exit seeking behavior R1 would remain at a level 4 care needs in February of 2026.
Per ED the facility is required to provide all care needs if that is what the resident is care assessment requires. Per interviews with 5 out of 5 residents stated rate structures and care assessments were explained and it was explained as care needs increase the care rate will increase.

Therefore based on the preponderance of evidence through records reviewed and interviews the allegation Staff do not do proper reassessments before a level change is determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred.
No deficiencies cited. An exit interview was conducted and a copy of this report this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2