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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006387
Report Date: 06/20/2025
Date Signed: 06/20/2025 04:17:53 PM

Unfounded


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
11/05/2024 and conducted by Evaluator Hanna Gough
COMPLAINT CONTROL NUMBER: 22-AS-20241105125907
FACILITY NAME:ANAHEIM VILLAFACILITY NUMBER:
306006387
ADMINISTRATOR:PARK, YOUNGFACILITY TYPE:
740
ADDRESS:3411 W BALL ROADTELEPHONE:
(714) 821-9660
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:210CENSUS: 83DATE:
06/20/2025
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Sandra ArzeTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff do not allow residents to make decisions regarding their care
Staff obtained hospice services on behalf of residents who do not meet the criteria for hospice care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hanna Gough made an unannounced inspection for the purpose of investigating the above allegations. LPA was greeted and granted entry by staff. LPA met with Care Coordinator (CC) Sandra Arze and spoke with Administrator (AD) Lea Wine over the phone. LPA discussed the purpose of the visit with CC and AD.

The investigation into the allegation that staff do not allow residents to make decisions regarding their care and staff obtained hospice services on behalf of residents who do not meet criteria for hospice care pertaining to Sierra Hospice Care revealed the following: during the course of the investigation file review revealed there was only one resident receiving hospice care from Sierra Hospice Care at the time of the complaint. Upon file review LPA observed resident #1 (R1) being referred to Sierra Hospice by a medical doctor on September 30, 2024, and was evaluated for intake by a Sierra Hospice nurse.

Continue on LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
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-20241105125907
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: ANAHEIM VILLA
FACILITY NUMBER: 306006387
VISIT DATE: 06/20/2025
NARRATIVE
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 R1 was referred to hospice due to a diagnosis of cachexia. LPA obtained R1s physicians report that states that R1 was receiving hospice care due to cachexia with a date of September 30, 2024. LPA observed hospice intake papers signed by R1s responsible party. LPA observed R1s LIC625 Needs and Services Plan was updated on September 30, 2024, stating that R1 would be receiving hospice comfort care due to R1s diagnosis as part of their new care plan. The Needs and Services Plan was signed by R1s responsible party. Interviews with 3 of 3 staff stating that they do not evaluate, intake or assist with hospice care plans. 3 of 3 staff informed LPA that they will give families information on different hospice programs and nothing more.

Interviews with 9 of 9 residents in care stated that they go to the day care by choice and if they decide not to go the facility staff do not force them, it is entirely their decision. LPA interviewed staff and 3 of 3 staff stated that if a resident declines to go, the facility staff honors their choices and makes note of it so they know who was left at the facility. Interview with day care staff informed LPA that they have not heard any complaints from the residents.

Based upon LPAs observations, interviews and information gathered during the investigation and review of all documents obtained, the preponderance of evidence standard has not been met, therefore the above allegations are deemed UNFOUNDED. Meaning that the allegations staff do not allow residents to make decisions regarding their care and staff obtained hospice services on behalf of residents who do not meet the criteria for hospice care was false, could not have happened and/or is without a reasonable basis. The department therefore dismissed the complaint.

An exit interview was conducted with CC Sandra Arze and AD Lea Wine and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2