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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006040
Report Date: 08/11/2026
Date Signed: 08/11/2026 09:45:00 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/03/2026 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260803134123
FACILITY NAME:CLEARWATER AT NORTH TUSTINFACILITY NUMBER:
306006040
ADMINISTRATOR:JENNIFER KORNMANNFACILITY TYPE:
740
ADDRESS:11901 & 11905 NEWPORT AVENUETELEPHONE:
(714) 656-9200
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:124CENSUS: 116DATE:
08/11/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Jennifer Kornmann - Executive Director TIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff are not ensuring residents personal information is kept confidential
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

The Department received the complaint on August 3, 2026. During today's visit LPA Mendivil toured both Assisted Living and Memory Care as well as interviewed staff. Regarding the allegation Staff are not ensuring residents personal information is kept confidential, the investigation revealed the following:

It was alleged that the staff are not ensuring resident's personal information is kept confidential as there was a ring camera placed in both medication rooms. LPA observed a camera placed at the far left of the celling in the assisted living medciation room, LPA also observed a sign advising that a camera is present in the room.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026
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 2
Control Number 22-AS-20260803134123
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CLEARWATER AT NORTH TUSTIN
FACILITY NUMBER: 306006040
VISIT DATE: 08/11/2026
NARRATIVE
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LPA observed a camera placed in a similar spot in the memory care medication room. LPA toured the facility and observed no additional cameras in common areas.

LPA Mendivil along with Maintenance Director Alex Mora viewed the live camera stream. LPA confirmed the video stream does not contain audio recordings. LPA confirmed with Executive Director Jennifer Kornmann that only management has access to view the cameras. While viewing the cameras LPA was not able to observe any identifiable resident information.

Therefore based on the preponderance of evidence through observations and interviews the allegation Staff are not ensuring residents personal information is kept confidential is determined to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2