<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006296
Report Date: 07/03/2025
Date Signed: 07/03/2025 01:21:33 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
08/02/2023 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20230802100821
FACILITY NAME:CROSS CREEK CAREFACILITY NUMBER:
306006296
ADMINISTRATOR:MANALO, JARRENFACILITY TYPE:
740
ADDRESS:138 E. 18TH STTELEPHONE:
(949) 722-1014
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY:14CENSUS: 10DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Rhadzivl BaylonTIME COMPLETED:
01:36 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff caused injuries to resident
Staff failed to treat residents with dignity and respect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. An initial investigation visit was conducted on September 23, 2023 by LPA Andrea Mendevil. During the course of the initial visit, LPA Mendivil interviewed staff and residents and obtained pertinent documents.

It was alleged staff caused injuries to resident and staff failed to treat residents with dignity and respect. During the investigation, LPA conducted interviews with residents in care and staff. LPA reviewed resident records and staff records.

The investigation determined as follows: regarding the allegation staff caused injuries to resident, seven residents and five staff were interviewed. Seven out of seven residents stated they are treated well by the caregivers and have never been physically abused in any way.
Continued on LIC9099-C dated 07/03/2025
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
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-20230802100821
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: CROSS CREEK CARE
FACILITY NUMBER: 306006296
VISIT DATE: 07/03/2025
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
Three out of seven residents added they have never witnessed any resident being physically abused by care staff. Five out of five staff interviewed stated they have never hit a resident. Two out of five staff added they have never witnessed other staff hit residents. Five out of five staff members stated they have received mandated reporting training. LPA reviewed staff records for nine staff members. The staff records included mandated reporting acknowledgments for each staff member.

Regarding the allegation staff failed to treat residents with dignity and respect, LPA interviewed seven residents and five staff. Seven out of seven residents stated they have never been yelled at. Five out of five staff interviewed stated they have never yelled at residents.

Therefore, based on resident interviews, staff interviews, records observed, and LPA observations, the allegations of staff caused injuries to a resident and allegation staff failed to treat residents with dignity and respect are therefore deemed unsubstantiated meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and a copy of the report was left with the facility representative.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2