306006403-7-17-2026-22-AS-AORZ-DWAT5N-20260724142549

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006403
Report Date: 07/17/2026
Date Signed: 07/17/2026 02:32:55 PM

Substantiated

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
07/09/2026 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20260709082714

FACILITY NAME:	ENDOR CARE HOME		FACILITY NUMBER:	306006403
ADMINISTRATOR:	DIXON, MITRA		FACILITY TYPE:	735
ADDRESS:	760 S. FAIRWAY LANE		TELEPHONE:	(714) 300-9512
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92807
CAPACITY:	6	CENSUS: 3	DATE:	07/17/2026
		UNANNOUNCED	TIME BEGAN:	08:22 AM
MET WITH:	Mitra Dixon		TIME COMPLETED:	12:52 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff does not provide adequate supervision resulting in resident wandering from facility.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced complaint investigation visit on July 17, 2026. Upon arrival, LPA met with Staff 1 (S1), Bridgette Stewart, and explained the purpose of the visit. Licensee Mitra Dixon arrived shortly thereafter.
The allegation was that “Staff does not provide adequate supervision resulting in resident wandering from facility.”
During the investigation, LPA interviewed two staff members, two clients, and one witness. S1 corroborated the allegation and stated that S1 believed Client 1 (C1) was permitted to leave the facility unassisted, provided that C1 did not travel a significant distance from the facility. LPA also interviewed Staff 2 (S2), who stated that S2 did not know whether C1 was permitted to leave the facility unassisted and did see C1 walk alone around the neighborhood.
{CONTINUE 9099C}

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026

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-20260709082714

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: ENDOR CARE HOME	FACILITY NUMBER: 306006403
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/17/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/20/2026 Section Cited CCR 85078(a)(1)	1 2 3 4 5 6 7	85078(a)(1) Responsibility for Providing Care and Supervision. The licensee shall provide those services identified in the client’s needs and services plan as necessary to meet the client’s needs.	1 2 3 4 5 6 7	A written statement confirming immediate compliance of C1’s current Physician’s Report and Appraisal/Needs and Services Plan.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interviews conducted and records reviewed, the licensee failed to provide C1 with the supervision identified in C1’s Appraisal/Needs and Services Plan. C1’s Physician’s Report states that C1 cannot leave the facility unassisted.	8 9 10 11 12 13 14	Licensee will develop and implement a written supervision procedure with staff, and send to LPA by POC due date
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 22-AS-20260709082714

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: ENDOR CARE HOME	FACILITY NUMBER: 306006403
	VISIT DATE: 07/17/2026

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

LPA interviewed C1, who stated that C1 independently walks through the neighborhood every day and that facility staff have never accompanied or supervised C1 during these walks. LPA also interviewed Client 2 (C2), who corroborated C1’s statement and confirmed that C1 regularly leaves the facility and walks through the neighborhood without staff supervision.
LPA interviewed Witness 1 (W1), who stated that W1 observed C1 walking alone in the neighborhood on July 14, 2026. W1 stated that no facility staff member was present or accompanying C1 at that time.
LPA reviewed C1’s Physician’s Report, which states that C1 is not permitted to leave the facility unassisted. LPA also reviewed C1’s Appraisal/Needs and Services Plan, which states that C1 requires another person to remain nearby while C1 is walking to prevent injury in all settings. The records establish that C1 requires supervision when walking outside the facility and cannot safely leave the facility independently.
Although S1 believed that C1 was permitted to leave the facility unassisted when remaining near the facility, C1’s Physician’s Report and Appraisal/Needs and Services Plan clearly identify C1’s supervision needs. Statements obtained from S1, C1, C2, and W1 consistently established that C1 regularly left the facility and walked through the neighborhood without the required staff supervision.
Based on interviews conducted and records reviewed, the Department determined that facility staff failed to provide C1 with the supervision required by C1’s Physician’s Report and Appraisal/Needs and Services Plan. Therefore, the allegation that “Staff does not provide adequate supervision resulting in resident wandering from facility” is Substantiated, meaning that the preponderance of evidence standard has been .
The facility is being cited under Title 22, Division 6, Chapter 1, California Code of Regulations, Section 85078(a)(1), Responsibility for Providing Care and Supervision.
An exit interview was conducted with Licensee Mitra Dixon. A copy of this report, the Appeal Rights, and the LIC 811, Confidential Names List, were provided at the conclusion of the visit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3