306005974-8-25-2026-22-AS-AORZ-DXDU9T-20260828152340

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005974
Report Date: 08/25/2026
Date Signed: 08/25/2026 10:11:21 AM

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
07/31/2026 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20260731160501

FACILITY NAME:	LA HABRA PLAZA		FACILITY NUMBER:	306005974
ADMINISTRATOR:	DIA, GERALD		FACILITY TYPE:	740
ADDRESS:	2630 RAINIER WAY		TELEPHONE:	(562) 905-0034
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	6	CENSUS: 5	DATE:	08/25/2026
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Administrator (AD) Gerald Dia		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff handle resident in a rough manner
Staff are mismanaging medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced subsequent complaint visit to deliver findings for the above allegations. LPA was greeted and granted entry by staff at 8:15am. LPA met with Administrator (AD) Gerald Dia and explained the purpose of the visit.

LPA reviewed the following documents for Resident #1 (R1): Medical Assessment dated 6/10/2026, Admissions Agreement signed and dated 6/11/2026, Letter of Agreement, Pre-Appraisal, Appraisal Needs and Services Plan, Facility Progress Notes and Medication Administration Records for July and August 2026.
Resident #1 (R1) moved into the facility on 6/13/2026 per Admissions Agreement, into a shared room. R1 has a diagnosis of Congestive Heart Failure, Hypertension, Type 2 Diabetes, a history of Cerebral Vascular Accidents and Traumatic Brain Injury. R1 is non-ambulatory and uses a wheelchair; due to partial paralysis on one side of the body, and requires assistance with medications and Activities of Daily Living.

(Continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026

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-20260731160501

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: LA HABRA PLAZA	FACILITY NUMBER: 306005974
	VISIT DATE: 08/25/2026

NARRATIVE

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(Continued from LIC 9099)

It was alleged that Staff handle resident in a rough manner. On the evening of 7/10/2026 at 9:30pm, Resident #1(R1) repeatedly rang a bell for assistance. Per Progress Notes, Staff #1 (S1) entered R1's room and retrieved a remote control that was out of reach for R1. A second time R1 asked S1 to straighten the bed sheets. Upon S1 leaving the room, R1 slammed the door. A few minutes later, S1 returned to R1's bedroom to inquire what was wrong and if there was anything else needed and R1 began to yell expletives at the staff member. R1 then came towards S1 with the wheelchair, still yelling, and punched R1 in the lower abdomen. LPA obtained photos from the staff member, showing bruising on the lower abdomen. R1 then backed away, grabbed a Gatorade bottle and thew it at the staff member.

Per Progress Notes, Staff #2 (S2) was in the bathroom and overheard the exchange. S2 attempted to calm R1. R1 notified the police and four La Habra Police Department (PD) officers arrived at 9:45pm. PD interviewed R1 and the staff. S1 showed PD where R1 had hit the staff member. PD asked staff if S1 needed to be assessed at Emergency Room or wanted to press charges and S1 declined. Officers stated R1 did not want contact with S1 but that the incident was resolved and no further action was needed.

LPA requested two of two staff files which include: Personnel Record, Health Screening and Training Documentation. Staff trainings are current and included topics such as: Personal Rights, Medication, Agitation, and Elder Abuse Reporting. There were no employee action forms on file. LPA also interviewed three of four staff members. One staff member had recently began working at the facility and could not confirm nor deny the allegation. Three of four staff members denied the allegation and stated it was the resident who hit the staff member. Staff documented the incident and AD changed the staff schedule so that S1's work duties did not have contact with R1. Per interviews, R1 also apologized to the staff member several weeks later and S1 is now able to assist R1 with any needs. Thus the allegation that Staff handle resident in a rough manner is Unsubstantiated.

LPA investigated the allegation that Staff are mismanaging medication. LPA audited R1's medications and obtained Medication Administration Records for July and August 2026. Per review, medications are being given as prescribed. LPA inquired if there were any instances where the wrong medication was provided; which caused R1 to have loose stools. Three of four staff interviewed denied this occurred. In May 2026, the
(Continued on LIC 9099-C1)

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20260731160501

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: LA HABRA PLAZA	FACILITY NUMBER: 306005974
	VISIT DATE: 08/25/2026

NARRATIVE

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(Continued from LIC 9099-C)

Department investigated another resident allegation regarding Staff are not providing residents with their medications as prescribed; which was Unsubstantiated. LPA also interviewed four of four residents, three of four staff and two of two witnesses. One of four residents stated the medication issues were resolved, one of four residents confirmed the allegation and two of four residents denied the allegation.

LPA interviewed three of four staff members. Three of four staff members denied the allegation that Staff are mismanaging medication One staff member could not confirm, nor deny the allegation. LPA interviewed two of two witnesses who stated they have not witnessed staff giving residents incorrect medications. LPA observed two of two staff obtained eight hours of medication training from 5/30-6/2/2026 and there were no employee action forms on file.

Based on LPA's file review, interviews and observations, the allegations that Staff handle resident in a rough manner and Staff are mismanaging medication are Unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was provided to Administrator (AD) Gerald Dia and a copy of this report and LIC 811s, were provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026

LIC9099 (FAS) - (06/04)

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