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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006116
Report Date: 05/13/2025
Date Signed: 05/13/2025 11:03:56 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
05/09/2023 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 22-AS-20230509165028
FACILITY NAME:FLOWERS FAMILY CAREFACILITY NUMBER:
306006116
ADMINISTRATOR:MARTINEZ, JONATHANFACILITY TYPE:
740
ADDRESS:1009 W 20TH ST.TELEPHONE:
(949) 274-0634
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:6CENSUS: DATE:
05/13/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:JONATHAN MARTINEZTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff physically abused resident in care causing a fracture.
INVESTIGATION FINDINGS:
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On 04/13/25, Donna Gurriere, Licensing Program Analyst (LPA) contacted the administrator via phone to deliver final findings regarding a complaint that was received on 05/09/23. LPA Gurriere spoke with Jonathan Martinez, Administrator and explained the purpose of the call.

Staff physically abused resident in care causing a fracture.

During the interview process, the licensee, the resident (Resident 1), a staff person and several others were interviewed. In addition, documents were reviewed and obtained to include medical records, Personnel Report, Physicians Report, Emergency Information, Admission Agreement and the Resident Facility Roster.



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
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 2
Control Number 22-AS-20230509165028
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: FLOWERS FAMILY CARE
FACILITY NUMBER: 306006116
VISIT DATE: 05/13/2025
NARRATIVE
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During the investigation of a complaint received on 05/09/23, it was reported that the resident (Resident 1) suffered a fractured hip while at the facility due to abuse by a staff person. During the interview process, the resident was inconsistent with her statements and at times reported that her injury was due to a fall. In addition, there was no medical evidence or supporting witness statements to substantiate an allegation of physical abuse. No actionable evidence was gathered during the investigation.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.

Licensee was advised a copy of this report will be sent via certified mail. Two copies of the report will be sent. The Licensee is to sign and return a copy to the Orange County Regional Office.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2