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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005927
Report Date: 06/13/2025
Date Signed: 06/13/2025 02:52:38 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
06/09/2025 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250609144753
FACILITY NAME:ELEONOR'S PLACE 4FACILITY NUMBER:
306005927
ADMINISTRATOR:AVENDANO, DARYLLFACILITY TYPE:
740
ADDRESS:24431 ZANDRA DRIVETELEPHONE:
(949) 547-5377
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
06/13/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Mark Ryan Cruz, administrator
Darryll Avendano, admininstrator		TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Licensee did not maintain facility in good repair.
INVESTIGATION FINDINGS:
1
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5
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7
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13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the allegations listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Mark Ryan Cruz was notified of the visit and arrived later to assist.

During the facility visit, LPA accompanied by staff conducted a tour of the physical plant and inspected the facility's shared bathroom. Resident records were requested and reviewed on site and copies obtained. Multiple resident interviews and three staff interviews were conducted while on the premises.

CONTINUED ON FORM LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
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 7
Control Number 22-AS-20250609144753
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: ELEONOR'S PLACE 4
FACILITY NUMBER: 306005927
VISIT DATE: 06/13/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Licensee did not maintain facility in good repair, the following has been concluded: During the observation and review of the facility's physical plant, it was evidenced that one of the two shared bathrooms used to provide toileting care to the residents had a loose wall-mounted thermostatic handle resulting in difficulty adjusting the water temperature reliably. There are also two faucets in the same bathroom, one of which is observed to be rotating loosely around its axis, also making water dispensation adjustments difficult. Additionally, water is being dispensed at a temperature of 130F, creating a risk of scalding. This additional deficiency is documented in a separate inspection report form LIC809.

Based on the observations and interviews conducted during the present visit, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the allegation is Substantiated. See LIC9099D for cited deficiency per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
06/09/2025 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250609144753

FACILITY NAME:ELEONOR'S PLACE 4FACILITY NUMBER:
306005927
ADMINISTRATOR:AVENDANO, DARYLLFACILITY TYPE:
740
ADDRESS:24431 ZANDRA DRIVETELEPHONE:
(949) 547-5377
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
06/13/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Mark Ryan Cruz, administratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not ensure resident received contracted service.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the allegations listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Mark Ryan Cruz was notified of the visit and arrived later to assist.

During the facility visit, LPA accompanied by staff conducted a tour of the physical plant and inspected the facility's shared bathroom. Resident records were requested and reviewed on site and copies obtained. Multiple resident interviews and three staff interviews were conducted while on the premises.

CONTINUED ON FORM LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
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 7
Control Number 22-AS-20250609144753
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: ELEONOR'S PLACE 4
FACILITY NUMBER: 306005927
VISIT DATE: 06/13/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099-A
Regarding the allegation that Licensee did not ensure resident received contracted service, the following has been concluded: Based on a review of admission agreements for the residents currently living at the facility, it was determined that Cable television was not explicitly listed as part of the basic services being provided upon admission and payment of the residence fee. A separate clause lists the provision of "Additional cable services" as "THIRD PARTY SERVICES: Provided at market rate and billed directly to the Resident or the authorized representative" with the clause verified to have been initialed by the resident upon signature of the admission agreement. Additionally, staff and resident interviews evidenced that there had been no additional charge to the residents related to cable service.

As a result, the allegation is determined to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with the facility and a copy of the report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
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
06/09/2025 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250609144753

FACILITY NAME:ELEONOR'S PLACE 4FACILITY NUMBER:
306005927
ADMINISTRATOR:AVENDANO, DARYLLFACILITY TYPE:
740
ADDRESS:24431 ZANDRA DRIVETELEPHONE:
(949) 547-5377
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
06/13/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Mark Ryan Cruz, administratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not assist resident with care needs in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the allegations listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Mark Ryan Cruz was notified of the visit and arrived later to assist.

During the facility visit, LPA accompanied by staff conducted a tour of the physical plant and inspected the facility's shared bathroom. Resident records were requested and reviewed on site and copies obtained. Multiple resident interviews and three staff interviews were conducted while on the premises.

CONTINUED ON FORM LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 22-AS-20250609144753
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: ELEONOR'S PLACE 4
FACILITY NUMBER: 306005927
VISIT DATE: 06/13/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099-A
Regarding the allegation that Staff did not assist resident with care needs in a timely manner, the following has been concluded: It was alleged that resident beddings were not being replaced in a timely manner by facility staff. During a tour of the physical plant, LPA verified all beds to be appropriately equipped with clean linens. Resident interviews and staff interviews conducted appear to indicate there are frequent checks and linen replacement on a weekly basis.

Based on the evidence gathered during the visit, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred.

An exit interview was conducted with the facility and a copy of the report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7
Control Number 22-AS-20250609144753
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: ELEONOR'S PLACE 4
FACILITY NUMBER: 306005927
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/14/2025
Section Cited
CCR
87303(a)
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Per CCR Section 87303(a) Maintenance and Operation: "(a) The facility shall be clean, safe, sanitary and in good repair at all times". This requirement is not met as evidenced by: Based on observation, two thermostatic faucets in one of the shared bathrooms were found to be loose and difficult to adjust.
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Licensee initiated measures to repair the defective faucets during the present visit. If the repair attempt is unsuccessful, a plumbing vendor will be contracted in coordination with the facility's landlord.
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This constitutes an immediate risk to the health, safety and personal rights of individuals 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.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7