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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005907
Report Date: 08/18/2026
Date Signed: 08/18/2026 03:51:00 PM

Substantiated


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
02/02/2022 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220202131436
FACILITY NAME:TESSA'S PLACE 1FACILITY NUMBER:
306005907
ADMINISTRATOR:AVENDANO, ELEONORFACILITY TYPE:
740
ADDRESS:26075 ARCADA DRIVETELEPHONE:
(949) 331-3822
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 5DATE:
08/18/2026
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Mark Cruz- AdministratorTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Resident sustained multiple falls while in care.
Staff did not seek medical attention for resident in care.
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPA) Jessica Cho arrived at the facility unannounced and met with Administrator (Admin) Mark Cruz to deliver findings for the above complaint allegations. During the investigation, the Department conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows:

Resident sustained multiple falls while in care:
Interviews conducted indicated Resident #1 (R1) sustained multiple falls while in care both witnessed and unwitnessed. Based on records reviewed, R1 needed max assistance for all Activities of Daily Living (ADLs) and mobility due to cognitive decline. Staff did not have a fall prevention plan in place to assist R1 in safe mobility. Therefore, the allegation resident sustained multiple falls while in care is substantiated

*** Report continued on 9099-C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026
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 3
Control Number 22-AS-20220202131436
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: TESSA'S PLACE 1
FACILITY NUMBER: 306005907
VISIT DATE: 08/18/2026
NARRATIVE
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Staff did not seek medical attention for resident in care:
Interviews conducted indicated that R1 was having severe pain and unable to walk or sit comfortably. Staff did not seek medical attention for R1 stating that hospice looked at R1 and said, “R1 is fine”. R1 had several falls since moving in to the facility that staff did not seek medical attention for due to R1 being on hospice. Therefore, the allegation staff did not seek medical attention for resident in care is substantiated.

Based on the information obtained for the allegations above, the allegations are SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Exit interview conducted with Administrator Mark Cruz, and a copy of the report and appeal rights were provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20220202131436
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: TESSA'S PLACE 1
FACILITY NUMBER: 306005907
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2026
Section Cited
CCR
87459(a)(7)(D)
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87459 Functional Capabilities (a) The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living. Such activities shall include, but not be limited to: (7) Physical condition, including: (D) Walking with or without equipment or other assistance.
This requirement was not met as evidenced by:
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Administrator Cruz stated a plan will be developed, proof of in-service with staff, and submit an Acknowledgement of Understanding of the said regulation to LPA via email by POC due date.
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Based on interviews and records, facility did not have a fall prevention in place for R1 who requires max assist for all ADLs and mobility which poses a potential Health, Safety, and/or Personal Rights risk to persons in care.
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Type B
08/25/2026
Section Cited
CCR
87465(a)(1)
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87465 Incidental Medical Needs (a)(1) - The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.
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Administrator Cruz stated proof of an in-service training reviewing PIN 25-06-ASC regarding placing 911 calls in the event of an incident/emergency for hospice residents and an Acknowledgement of Understanding of the said deficiency will be submitted to LPA by POC due date.
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Based on interviews and record review, facility did not seek medical attention for R1 due to R1 being on hospice which poses a potential Health, Safety, and/or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026
LIC9099 (FAS) - (06/04)
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