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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005929
Report Date: 07/04/2025
Date Signed: 07/04/2025 02:23:39 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
07/02/2025 and conducted by Evaluator RoseMarie Ruppert
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250702131731
FACILITY NAME:MARTINO LOVING CARE, INC.FACILITY NUMBER:
306005929
ADMINISTRATOR:TRIEU, THANHFACILITY TYPE:
740
ADDRESS:1904 W. RANDOM DRIVETELEPHONE:
(714) 858-3535
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 0DATE:
07/04/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Residents abandoned by facility staff.
Resident(s) medications are not being managed as prescribed.
Unidentified and uncleared individual(s) residing in the facility.
Facility is operating outside of its plan of operation.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Rose Ruppert and Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegations listed above. LPAs arrived at the facility on July 4, 2025 at 1:00pm. No one was present at the facility. c

During the course of the investigation, LPAs toured the facility. LPAs interviewed Residents #1 (R1), Resident #2 (R2) and Resident #3 (R3) and Witness #1 (W1) and Witness #2 (W2). The facility has no resident records. On July 2, 2025. LPA conducted the initial 10-day visit.

The investigation into the allegation, Residents abandoned by facility staff, revealed the following. On July 2, 2025 when LPA Ruppert made the initial 10-day visit there was no staff at the facility. Staff 1 arrived 30 minutes later. LPA attempted to call the Administrator, but they could not be reached.

(Continued on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 07/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/04/2025
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 5
Control Number 22-AS-20250702131731
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: MARTINO LOVING CARE, INC.
FACILITY NUMBER: 306005929
VISIT DATE: 07/04/2025
NARRATIVE
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(Continued LIC (9099)

The Department has made numerous attempts to contact the Licensee but the Licensee has remained unresponsive. There is no current staff roster at the facility. LPAs could not locate any facility records during the tour of the facility. Three of three residents confirmed that there is no care staff that remains in the facility at night. Staff 1 reported they have no knowledge of any facility documents or records.

Staff 1 is not background cleared and is not associated to the facility. On July 3, 2025 Staff 1 left the facility while R1 was still present. Based on the evidence gathered through interviews and observations the preponderance of evidence standard has been met, therefore the allegation, Residents abandoned by facility staff is substantiated.

The investigation into the allegation, Resident(s) medications are not being managed as prescribed revealed the following. On July 3, 2025 LPA Ruppert LPA observed all 3 residents stored their medication in their rooms. Three out of three residents interviewed reported they administered their own medications. There are no resident records at the facility. There are no medication records that could be reviewed. Three out of three residents interviewed could not explain what their medications are for and when they should take them. Staff 1 reported that they have assisted Resident 1 and Resident 2 but not with their medications. None of the residents receive any medication management. Based on the evidence gathered the preponderance of evidence standard has been met, therefore the allegation is substantiated.

The investigation into the allegation, Unidentified and uncleared individual(s) residing in the facility, revealed the following. On July 3, 2025 LPA Ruppert toured the facility. LPA Ruppert observed a children’s inflatable pool with water in the backyard and an Additional Dwelling Unit (ADU). LPA knocked on the door of the ADU and discovered a female and two children residing in the ADU. LPA introduced self and asked for information. Female stated the spouse handles all interactions regarding rental payment and did not have any information for LPA and LTCO. LPA Ruppert interviewed Staff 1. Staff 1 is not background cleared and not associated to the facility. Based on the evidence gathered the preponderance of evidence standard has been, therefore the allegation, unidentified and uncleared individual(s) residing in the facility is substantiated.

(Continued on LIC 9099C1)

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 07/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20250702131731
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: MARTINO LOVING CARE, INC.
FACILITY NUMBER: 306005929
VISIT DATE: 07/04/2025
NARRATIVE
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(Continued from LIC 9099C)

The investigation into the allegation, facility is operating outside of its plan of operation, revealed the following. LPA and Long Term Care Ombudsman spoke jointly with Licensee and Regional Manager on the phone. Licensee, who owns the property, stated the license was surrendered four years ago; although the facility pre-licensing visit was 3/24/2021. LPA and LTCO called the Administrator on file, Thanh Trieu, who stated the license was not surrendered and he hung up during the call with LTCO, LPA and Regional Manager. Staff 1 (S1) stated they only worked until 8pm and then leaves the facility. The tenant returns to the facility in the evening and is on-site. And the tenants reside in the ADU. None of the tenants, nor staff member have criminal background clearance, nor training, to provide care. The preponderance of evidence standard has been met therefore the allegation, facility is operating outside of its plan of operation, is substantiated.

See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. Immediate civil penalties are being assessed (See LIC421IMs). An immediate civil penalty for $500 is being assessed for staff not being background cleared, which is a repeat violation ($500 for the violation + $500 for the repeat violation = $1000) and $500 X 3 persons was assessed and is $1500 (LIC 421BG) and an immediate civil penalty for $500 is being assessed for the lack of care and supervision (LIC421IM). A Civil Penalty is pending determination by the Community Care Licensing Division (CCLD) per Health & Safety Code section 1569.49(f). No one was present at the facility. A copy of the report along with Appeal Rights were left at the facility and were emailed to the Licensee.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 07/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20250702131731
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: MARTINO LOVING CARE, INC.
FACILITY NUMBER: 306005929
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/05/2025
Section Cited
CCR
87464(f)(1)
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87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: On July 2, 2025, LPA arrived
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The Licensee will provide staffing for the three residents in care or relocate the residents from the facility.
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at 3:40pm and and there were no staff present. A staff member showed up 30 minutes later and admitted to leaving at 8 PM. There is no staff during the night. This poses and immediate health and safety risk to residents in care .LIC 421IM An immediate civil penalty is being assessed for $500.
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Type A
07/05/2025
Section Cited
CCR
87465(h)(2)
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877465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees
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The Licensee will secure resident medications or relocate the residents from the facility.
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responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: On July 2nd and 3rd, LPAs observed medications accessible for three of three residents. This poses and immediate health and safety 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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 07/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/04/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20250702131731
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: MARTINO LOVING CARE, INC.
FACILITY NUMBER: 306005929
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/05/2025
Section Cited
CCR
87355(a)
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87355 Criminal Record Clearance (a)The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny…employment…in the facility… This requirement is not met as evidenced by:
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Licensee agrees to have all tenants and staff associated to the facility as required by CCR 87355. Licensee to submit proof of background clearance to LPA by POC due date.
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LPA observed Staff 1, Tenant 1, Tenant 2 and Tenant 3 at the facility are not background cleared and associated to the facility. This poses an immediate health and safety risk to residents. An immediate civl penalty is assessed. A repeat violation of $1000 + $500 X 3 persons = $2500.
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Type A
07/05/2025
Section Cited
CCR
87208(a)
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87208 Plan of Operation a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49…. This requirement is not met as evidenced by:
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Licensee agrees to submit a new application and facility sketch to add ADU for fire clearance. Licensee agrees to have staff and residents only at the facility and to comply with the approved Plan of Operation on file.
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On July 2-3, LPAs could not find records for 3 of 3 residents. Two tenants also reside on the property, one in Room #1 and a family resides in the Additional Dwelling Unit (ADU) with two adults and two minor children. The ADU is not included in the facility sketch. This poses an immediate health and safety 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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 07/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/04/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5