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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005844
Report Date: 12/18/2025
Date Signed: 12/18/2025 03:19:01 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
02/11/2022 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220211163124
FACILITY NAME:BLUE SKIES OF LAGUNA NIGUELFACILITY NUMBER:
306005844
ADMINISTRATOR:CELIS, GERALDINA PFACILITY TYPE:
740
ADDRESS:25437 VIA ESTUDIOTELEPHONE:
(949) 326-0311
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:0CENSUS: 0DATE:
12/18/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Facility closedTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not follow resident's hospice care plan appropriately
Resident's records were not properly maintained
Facility has pests
INVESTIGATION FINDINGS:
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On December 18, 2025, Licensing Program Analyst (LPA) Brandon Lopez made a telephone call to Licensee (LI) Hanh Dao to deliver the complaint findings. However, the LI did not answer and LPA left a voicemail explaining the reason for his call. Additionally, LPA attempted to contact the LI multiple times during this investigation including on December 4, 2025, December 5, 2025, and December 18, 2025, due to the facility being closed effective October 13, 2025.

Regarding the allegations that, staff did not follow resident's hospice care plan appropriately and resident's records were not properly maintained, the following has been concluded: It was alleged that Resident #1 (R1) hospice care plan was not followed appropriately and R1's records were not properly maintained. R1 was admitted to the facility on February 19, 2020 and moved out of the facility on January 25, 2022. The Department received the complaint on February 11, 2022. Due to the facility being closed effective October 13, 2025, the Department was unable to review or obtain any relevant documents to this complaint such as facility records, resident records, staff records, or any records for R1. Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
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 2
Control Number 22-AS-20220211163124
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: BLUE SKIES OF LAGUNA NIGUEL
FACILITY NUMBER: 306005844
VISIT DATE: 12/18/2025
NARRATIVE
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In an attempt to obtain relevant documents for this complaint, a collateral visit was conducted on December 4, 2025, to the current licensed facility at the location, Amore Senior Living II - 306006698. During the collateral visit on December 4, 2025, the Department conducted three resident interviews. However, the three residents interviewed were all admitted to the facility on August 2023, or later. Furthermore, the three residents interviewed were unfamiliar with R1 or any incidents that occurred prior to their admission. During the collateral visit, the Department also conducted two staff interviews. Both staff interviewed started employment with the facility on October 2023, or after. Both staff interviewed were unfamiliar with R1 or any incidents that occurred prior to the start of their employment.

Regarding the allegation that, facility has pests, the following has been concluded: The three residents interviewed during this investigation denied ever seeing any pest since they have been admitted to the facility. However, the three residents were unable to provide any information about any issues prior to their admissions to the facility. The two staff interviewed during this investigation denied pest ever being present since they have worked at the facility. However, both staff were also unable to provide any information about issues prior to their employment with the facility. During the collateral visit conducted on December 4, 2025, to the current licensed facility at the location, Amore Senior Living II - 306006698, LPA conducted a tour of the interior and exterior portions of the facility. LPA inspected areas such as the resident bedrooms, resident bathrooms, the kitchen, the living room, the garage, and observed them to be free of any pest.

Based on the limited information gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. 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, all three allegations are deemed UNSUBSTANTIATED.


The facility was closed effective October 13, 2025. Attempts to reach Licensee Hanh Dao to conduct an exit interview were unsuccessful. A copy of this report will be certify mailed to the Licensee Hanh Dao's last known address.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2