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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005946
Report Date: 10/23/2025
Date Signed: 10/23/2025 04:30:33 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
10/04/2021 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211004152934
FACILITY NAME:SERRA SOLFACILITY NUMBER:
306005946
ADMINISTRATOR:LOPEZ, JANELLEFACILITY TYPE:
740
ADDRESS:31451 AVENIDA LOS CERRITOSTELEPHONE:
(916) 836-8022
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:70CENSUS: 54DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Becky LangdonTIME COMPLETED:
12:31 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents left unattended for extended periods of time
Facility staffing is not sufficient to meet resident's needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LIcensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to continue the investigation into the allegations listed above. LPA met with Operations Specialist Becky Langdon and explained the reason for the visit. During the course of the investigation LPA toured the facility, interviewed staff and residents and reviewed faciltiy and resident records.

The investigation into the allegation, Residents left unattended for extended periods of time, revealed the following. It was reported that Resident 1 (R1) was left unattended in their bed for 13 hours and no staff checked in on them during the 13 hours they were in bed. No other details concerning this allegation were provided. R1 moved into the facility on September 10, 2021 and went to the hospital on September 22, 2021 and never returned to the facility. R1 has been diagnosed with Dementia. 5 out of 5 staff members interviewed reported that none of residents including R1 have ever been unattended and left in bed for 13 hours. A review of R1's observation notes does not show R1 ever spent 13 hours in bed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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 4
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
10/04/2021 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211004152934

FACILITY NAME:SERRA SOLFACILITY NUMBER:
306005946
ADMINISTRATOR:LOPEZ, JANELLEFACILITY TYPE:
740
ADDRESS:31451 AVENIDA LOS CERRITOSTELEPHONE:
(916) 836-8022
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:70CENSUS: 54DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Becky LangdonTIME COMPLETED:
12:31 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility Administrator is not currently certified
Facility does not have complete resident records
Facility did not have a resident appraised
Facility staff is not properly trained
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to continue the investigation into the allegations listed above. LPA met with Administrator Becky Langdon and explained the reason for the visit. During the course of the investigation LPA toured the facility, interviewed staff and residents and reviewed facility and resident records.

The investigation into the allegation, facility Administrator is not currently certified revealed the following. It was reported that Susie Peterson does not have a valid Administrator's certificate and she is the facility Administrator. At the time the complaint was filed the facility Administrator was Jannele Lopez who had an Administrator's certificate which was valid October 4, 2020 to October 3, 2022. Susie Peterson was the Executive Director but not the facility Administrator. The facility has always had an Administrator with a valid Administrator's certificate. Based on the evidence gathered the allegation is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20211004152934
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: SERRA SOL
FACILITY NUMBER: 306005946
VISIT DATE: 10/23/2025
NARRATIVE
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32
The investigation into the allegation, facility does not have complete resident records, revealed the following. It was reported that Resident 2 (R2) did not have a care plan and no medication records. A review of facility records shows R2 moved in September 24, 2021 and had a care plan dated September 23, 2021 and a care plan dated October 6 and a medication list for September 2021. LPA reviewed 3 other resident files for Resident 1 (R1), Resident 3 (R3) and Resident 4 (R4). No discrepancies observed. Based on the evidence gathered the allegation is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

The investigation into the allegation, facility did not have a resident appraised, revealed the following. It was reported that R2 was not appraised. R2 moved into the facility September 24, 2021. A review of R2's records shows R2 was assessed on September 23, 2021 prior to move in and assessed on October 6, 2021 after they moved in the facilty. Based on the evidence gathered the allegation is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

The investigation into the allegation, facility staff is not properly trained, revealed the following. It was reported that Staff 1 (S1) had no training, experience or certifications. A review of records shows S1 had over 24 hours of training and 16 hours of on the job training (one on one training with another caregiver) in topics such as, care of residents with Dementia, basic care skills, providing medication assistance, resident rights and CPR certification. A review of 3 other caregiver files showed all 3 caregivers had 40 hours of initial training. Based on the evidence gathered the allegation is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20211004152934
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: SERRA SOL
FACILITY NUMBER: 306005946
VISIT DATE: 10/23/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on the evidence gathered the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, facility staffing is not sufficient to meet resident's needs, revealed the following. It was reported that a lack of staff has resulted in multiple falls from residents. It also was reported that Resident 5 (R5) passed away at the facility. A review of records shows, R5 was sent to the hospital on July 9, 2021 and never returned to the facility. R5 passed away at the hospital on July 15, 2021. A review of the staff schedule for October and September 2021 show 18 caregivers and med-techs. 2 caregivers and 1 med-tech are scheduled for the AM shift (6am - 2pm) and PM shift (2pm-10pm). 1 caregiver and 1 med-tech for NOC shift (10pm - 6am). The Executive Director reported they are in the process of hiring more staff but at this time they only have 14 residents so there is enough staff to care for all the residents. 5 out of 5 staff reported there is enough staff to meet the needs of the residents. A review of incident reports received for September and October 2021 show only 2 incidents reports were received from the facility. One report noted a resident was found sitting on the floor and the other report noted a resident was lethargic. Neither report raised any concerns for the Agency and did not require follow up. Based on the evidence gathered the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4