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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005835
Report Date: 12/09/2025
Date Signed: 12/09/2025 03:43:42 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
05/09/2024 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240509142005
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: 54DATE:
12/09/2025
UNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Erin Palposi-Executive DirectorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff are not providing adequate billing services to resident
Staff did not ensure resident's sink was not in disrepair
Staff inappropriately installed a sensor on resident's door
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
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10
11
12
13
Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on May 9, 2024. LPA was greeted and granted entry into the facility and met with Executive Director (ED) Erin Palposi. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that staff are not providing adequate billing services to resident. Regarding the allegation the following was revealed: During the course of the interviews six of eight individuals interviewed denied the allegation. During the course of the investigation LPA reviewed documents including the Kirkwood Orange Admission Agreement dated February 16, 2024, for Resident 1 (R1). Per Admission Agreement, under Monthly Fee it states Resident will receive monthly a statement itemizing all separate charges incurred by Resident. Per Admission Agreement, under Modification-Rate Increases it states if there is a change in condition, you will begin being charged for the new level of care services immediately. LPA reviewed documents including the Kirkwood Orange monthly statements dated March 2024 through May 2024.
CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
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 4
Control Number 22-AS-20240509142005
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: KIRKWOOD ORANGE
FACILITY NUMBER: 306005835
VISIT DATE: 12/09/2025
NARRATIVE
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Per monthly statements, it includes the date, description and charged amount. During the interviews with residents, R2-R4 reported that they have not had issues with their billing and/or stated that they are being provided with adequate billing services. During the course of the interviews with staff, Staff 1 (S1) reported that the resident was billed properly for the services she was provided.

Regarding the allegation that staff did not ensure resident’s sink was not in disrepair, the following was revealed: During the initial visit on May 16, 2024, and subsequent visit on November 21, 2025, LPA tour R1’s bedroom and observed that the sink was in good repair. During the interviews with residents, R2 reported that she has no issues with her sink and stated that maintenance will help quickly if needed. Per R3, the water goes down her sink properly. R4 stated that he has not had issues with his sink and reported that maintenance will assist the residents the same day. During the interviews with staff, S1 reported that they have a system where staff can open a ticket for repair/work orders. Per S1, staff always ensure that the residents’ sinks are working properly. S3 reported that R1 never complained about her sink being broken or clogged.

Regarding the allegation that staff inappropriately installed a sensor on resident’s door, the following was revealed: During the initial and subsequent visits LPA tour R1’s bedroom and did not observe a sensor on the resident’s door. During the interviews with residents, R2-R4 reported that they have never seen a sensor on the residents' doors. During the interviews with staff, S1 reported that the facility never installs sensors on the residents’ doors. Per S2, she has never seen a sensor on the residents' doors. S3 stated that during the morning rounds that staff notice an aerial alarm/ sensor on the resident's door and reported that the next day the sensor was gone. Per S3, the facility staff did not place the sensor on the resident’s door.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.

LPA conducted an exit interview with ED Palposi, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
05/09/2024 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240509142005

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: 54DATE:
12/09/2025
UNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Erin Palposi-Executive DirectorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are mismanaging resident's medication
Staff are not keeping track of resident's documents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on May 9, 2024. LPA was greeted and granted entry into the facility and met with Executive Director (ED) Erin Palposi. LPA explained the reason for the visit.

This Department has investigated the complaint alleging that staff are mismanaging resident's medication. Regarding the allegation the following was revealed: During the investigation LPA reviewed the Medication Administration Record (MAR) dated February though April 2024, for Resident 1 (R1). Per MAR, R1's medications were being given as prescribed. During the interviews with residents, R2 reported that she gets her medications as prescribed. Per R3, staff manage his medications and reported that staff do a good job. During the interviews with staff, Staff 2 (S2) and S3 reported that staff do not mismanage the residents' medications.
CONTINUED on LIC9099-C...
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20240509142005
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: KIRKWOOD ORANGE
FACILITY NUMBER: 306005835
VISIT DATE: 12/09/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
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Regarding the allegation that staff are not keeping track of resident's documents, the following was revealed: During the investigation LPA review the Resident file for R1. LPA observed that the file for R1 included the following documentation: Admission Agreement, Medical Assessment, Consent Forms, Identification and Emergency Information, Preplacement Appraisal Information, MAR, Resident Assessment, maintenance work orders, Resident Personal Rights, Safeguards for Property/Valuables and Cash Resources, and monthly billing statements. During the interviews with residents, R2-R4 reported that they have not had issues with their documents and/or reported that their Responsible Party (RP) received a copy of their records. During the interviews with staff, S2 reported that staff keep accurate track of the resident documents. Per S3, staff provided R1's RP with all documentation requested.

Therefore, the allegations are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or are without a reasonable basis.

LPA Ramirez conducted an exit interview with ED Palposi and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4