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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006132
Report Date: 07/08/2026
Date Signed: 07/08/2026 09:16:37 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
05/12/2026 and conducted by Evaluator Hanna Gough
COMPLAINT CONTROL NUMBER: 22-AS-20260512085104
FACILITY NAME:BEVERLY HOMEFACILITY NUMBER:
306006132
ADMINISTRATOR:CHEA, PAULFACILITY TYPE:
735
ADDRESS:1183 W. CHATEAU AVETELEPHONE:
(714) 215-4396
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:6CENSUS: 2DATE:
07/08/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Paul Chea TIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Client sustained unexplained injury due to lack of care and supervision.
Client sustained abuse at the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to conduct an investigation for the above mentioned complaint allegations. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Paul Chea and discussed the purpose of the visit.

The investigation into the facility allegations of Client sustained unexplained injury due to lack of care and supervision and Client sustained abuse at the facility revealed the following: It was alleged that Client #1 (C1) sustained an injury at the facility due to a lack of care and supervision and C1 sustained abuse at the facility. LPA reviewed an Admission Agreement for C1 stating that C1 moved into the facility on March 1, 2026. LPA reviewed a Pre-Placement information form dated March 5, 2026, stating that C1 has been observed to be aggressive when frustrated. LPA reviewed a First Quarter Review Plan dated March 5, 2026, stating that C1s behaviors continued to be sporadic with anxiety and behaviors such as physical aggression, elopement, and irritated behaviors. Continue on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
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-20260512085104
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: BEVERLY HOME
FACILITY NUMBER: 306006132
VISIT DATE: 07/08/2026
NARRATIVE
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LPA reviewed the Medication Administration Record (MAR) for C1 for the months of March and April and it appears all medications were given as prescribed with PRNs being administered due to agitation. LPA reviewed daily progress notes for C1 dated March 1, 2026, to April 15, 2026. Staff did not notate any forms of aggression done to C1 but forms of aggression done by C1 to themselves, staff and other clients in care. The daily progress notes also noted that C1 had daily behaviors and agitation while they were at the facility.

Interviews with clients revealed that two of three clients were unable to confirm or deny the allegations. One of three clients informed LPA that staff are nice and have not harmed them and they have no seen staff harm other clients in any way. One of three clients informed LPA that they have hit another client before but could not recall who, why and when.

LPA was unable to interview C1 due to no longer residing at the facility.

Interviews with staff revealed that three of three staff have never observed other staff hit or abuse clients in care. Three of three staff informed LPA that they have not hit or abused clients themselves. Three of three staff informed LPA that they have not seen client on client abuse in the facility. Three of three staff informed LPA that they were informed about a chipped tooth after C1 had left the facility, but did not see any incident occur where C1 would have chipped their tooth. Three of three staff informed LPA that the only thing observed that could be connected to C1s chipped tooth was that C1 would clench their jaw tightly shut during behaviors. Three of three staff informed LPA that C1s glasses were broken by another client in the facility, but no physical altercation occurred between the clients and the incident did not involve C1 at all.

Interviews with Witness #1( W1) revealed that they noticed a chipped tooth and a bruise on C1, but did not know where it came from and did not have any evidence of it being from a lack of care and supervision or abuse from facility staff. W1 informed LPA that they are not sure if anything did happen at the facility.

Interviews with Witness #2 (W2) revealed that when they saw C1 for meetings and C1 was observed to be at their baseline for behaviors. W2 informed LPA that they were told that C1s behaviors were not due to a medication restraint but was trauma based and was unable to elaborate further. W2 informed LPA that they were not sure if the facility was a good fit for C1 due to not residing in a residential facility for over 15 years.

LPA reviewed personal rights and abuse training for three of three staff.

Continue on 9099C

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260512085104
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: BEVERLY HOME
FACILITY NUMBER: 306006132
VISIT DATE: 07/08/2026
NARRATIVE
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Based on information gathered and interviews conducted, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegations are deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3