306006387-9-9-2026-22-AS-KSGH-DY9QWP-20260925123215

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006387
Report Date: 09/09/2026
Date Signed: 09/09/2026 04:45:10 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
07/17/2026 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260717092250

FACILITY NAME:	ANAHEIM VILLA		FACILITY NUMBER:	306006387
ADMINISTRATOR:	WINE, LEA		FACILITY TYPE:	740
ADDRESS:	3411 W BALL ROAD		TELEPHONE:	(714) 821-9660
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	210	CENSUS: 142	DATE:	09/09/2026
		UNANNOUNCED	TIME BEGAN:	07:50 AM
MET WITH:	Christine Chon		TIME COMPLETED:	08:30 AM

ALLEGATION(S):

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Staff did not issue responsible party proper refund.
Staff did not allow visitors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit regarding the complaint allegations above. LPA Haley was greeted by staff and explained the reason for the visit upon entering the facility. The complaint investigation consisted of interviews with facility staff, resident family members, a witness, and a document review.

Regarding the allegation: Staff did not issue responsible party proper refund.

During the investigation it was discovered, Resident 1 (R1) and Resident 2 (R2) were both scheduled to be admitted to the facility; however only R1 was admitted. R2 did not want to stay at the facility and was eventually sent to the hospital. Room and board fees were paid for both residents for the month of March 2026. Eventually a credit was applied for R1 for the dates of March 17, 2026 – March 31, 2026.

Continued on LIC9099C

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20260717092250

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: 09/09/2026

NARRATIVE

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The credit balance was applied to R2’s April monthly room and board fees as the family of the R2 wanted the room held for R1 at this time. On April 3, 2026, it was decided that R2 was not going to be moving into the facility and a credit was applied for the room and board fees for April 4, 2026, through April 30, 2026. The facility charged a room and board fee for three days (April 1 – 3) and deducted the amount from the credit balance and issued the remaining credit balance in a refund check dated June 26, 2026. A copy of the refund check and an accounting ledger of all the room and board fees that were charged and all the payments that were made to the facility was provided.

Regarding the allegation: Staff did not allow visitors.
During the investigation it was discovered Resident 1 (R1) and Resident 2 (R2) had two children involved in the care of the residents. One sibling lived out of state and another sibling was local. The local siblings would show up to the facility to visit a lot. When speaking to a family member of both residents, it was discovered staff never told the local sibling they could not visit the facility. The facility had conversations with the out of state siblings regarding the local sibling’s behavior when they would come to the facility and the possibly of that sibling clogging a shower drain in R1’s bedroom. However, it was discovered, staff never told the local sibling they could not come and visit, and the staff never told the sibling that was out of state that the local sibling could not come and visit the facility.

Based on the information gathered through interviews and document review, the allegations are deemed unfounded, meaning the allegations are 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: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026

LIC9099 (FAS) - (06/04)

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