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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005927
Report Date: 07/08/2026
Date Signed: 07/08/2026 04:44:32 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
06/30/2026 and conducted by Evaluator Garlli Tat
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260630144428
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:
07/08/2026
UNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Mark CruzTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility staff is not adequately assisting resident with toileting care.
Facility staff are not managing medication as needed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit for the purpose of initiating the complaint investigation into the above allegations. LPA met with Administrator (Admin) Mark Cruz and stated the reason for the visit. During the course of the investigation, LPA successfully interviewed two out of five residents and five out of five staff. LPA also obtained copies of the Resident and staff roster, Face Sheet, Physician's Report, Admission Agreement, care plan, ISP, and progress notes.

The investigation revealed the following: Regarding the allegation, Facility staff is not adequately assisting resident with toileting care, it was reported that Resident #1's (R1) commode is not being emptied in a timely manner and the two bathrooms available are often occupied. LPA observed R1's room and observed that the commode had not been emptied at the time of the visit. LPA observed that the two bathrooms are not always occupied. Two out of two residents denied the allegation and four out of five staff stated the commode is cleaned on a regular basis and the bathrooms are available for use. Continued on LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Garlli Tat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
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 5
Control Number 22-AS-20260630144428
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: 07/08/2026
NARRATIVE
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Regarding the allegation, Facility staff are not managing medication as needed, it was reported that R1 was not informed about medication being delivered. Based on record review, R1 is ambulatory, independent with activities of daily living, and manages their own medications. Based on the interviews, two out of two residents stated their medications are administered timely. Four out of five staff interviewed stated the medication is provided to R1 upon receipt. Based on interviews, there was a delivery error of the pharmacy at the facility.

Based on the observations made, interviews conducted, and the records reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the following allegations: Facility staff is not adequately assisting resident with toileting care and Facility staff are not managing medication as needed are deemed Unsubstantiated.

An exit interview was conducted with Administrator Mark Cruz, and a copy of this report was provided at the exit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Garlli Tat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
06/30/2026 and conducted by Evaluator Garlli Tat
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260630144428

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:
07/08/2026
UNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Mark CruzTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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2
3
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5
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9
Facility staff is not safeguarding a resident's belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit for the purpose of initiating the complaint investigation into the above allegation. LPA met with Administrator (Admin) Mark Cruz and stated the reason for the visit. During the course of the investigation, LPA successfully interviewed two out of five residents and five out of five staff. LPA also obtained copies of the Resident and staff roster, Face Sheet, Physician's Report, Admission Agreement, care plan, ISP, and progress notes.

Regarding the allegation, Facility staff is not safeguarding a resident's belongings, it was reported that R1's laundry were misplaced at the facility. It was alleged that R1's clothes were found in another resident's closet. LPA toured the laundry room, where a load of laundry was being washed. Two out of two residents interviewed stated they had never had their laundry misplaced. Two out of five staff interviewed admitted there was an instance where R1's laundry was misplaced. Based on record view, progress notes indicated that R1's clothing item was found in another resident's closet.
Continued on LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Garlli Tat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
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 5
Control Number 22-AS-20260630144428
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: 07/08/2026
NARRATIVE
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Based on evidence gathered through interviews and document review, the preponderance of evidence has been met, therefore, the above allegation is found to be Substantiated. Violations are being cited per Title 22 of California Code of Regulations. See LIC 9099-D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with Administrator and a copy of this LIC9099-D, along with a copy of the Appeal Rights were left at the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Garlli Tat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 22-AS-20260630144428
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: 07/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2026
Section Cited
CCR
87217(b)
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(b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources. (cont.)
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Licensee will train all staff to separate all articles of clothing accordingly during laundry services and provide proof of correction to LPA by POC due date.
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This requirement was not met as evidenced by: Resident's piece of clothing was mixed up and found in another resident's closet.
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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: Garlli Tat
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5