306006421-8-15-2025-22-AS-LMOA-DKT2VE-20250822174350

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006421
Report Date: 08/15/2025
Date Signed: 08/15/2025 04:46:27 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
07/03/2025 and conducted by Evaluator Edward Kim

COMPLAINT CONTROL NUMBER: 22-AS-20250703163459

FACILITY NAME:	BAYSHIRE YORBA LINDA		FACILITY NUMBER:	306006421
ADMINISTRATOR:	COLEMAN, CHAD		FACILITY TYPE:	741
ADDRESS:	17803 IMPERIAL HWY		TELEPHONE:	(714) 777-9666
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	114	CENSUS: 94	DATE:	08/15/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Executive Director- Austin Morris		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility does not have hot water.

INVESTIGATION FINDINGS:

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On August 15, 2025, Licensing Program Analyst (LPA) Edward Kim conducted a subsequent complaint visit to deliver complaint investigation findings. LPA met with Executive Director (ED) Austin Morris and explained the purpose of today’s visit.

The investigation consisted of the following: On July 10, 2025, LPA Kim toured the facility with ED Austin Morris. LPA Kim requested and obtained copies of the resident and staff rosters, staff schedule, and other pertinent documentation.

The investigation revealed the following:

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025

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-20250703163459

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: BAYSHIRE YORBA LINDA	FACILITY NUMBER: 306006421
	VISIT DATE: 08/15/2025

NARRATIVE

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Allegation: Facility does not have hot water.

It is alleged that half of the building is experiencing issues with hot water. It also alleged facility is not resolving the issues with a plumber and is shutting the water off intermittently. Based on observations, on August 15, 2025, LPA measured the temperatures in the exercise room on the second floor that measured at 115.0 degrees F, on the first floor common bathroom across the beauty salon that measured at 113.5 degrees F, and twelve bedrooms that measured in room 103 at 117.3 degrees F, room 106 at 118.0 degrees F, room 112 at 116.6 degrees F, room 122 112.6 degrees F, room 126 at 114.4 degrees F, room 135 at 113.7 degrees F, room 132 at 116.2 degrees F, room 150 at 115.7 degrees F, room 218 at 114.8 degrees F, room 226 at 114.4 degrees F, and room 260 at 109.7 degrees F.

Based on interviews conducted, one witness and three out of twelve staff confirmed the allegation. Five out of twelve staff and five out of five residents denied the allegation. Three out of twelve staff did not confirm or deny the allegation. S1, S2, S3, S4, and S5 stated hot water for the showers and the bathroom sinks would take about 5 minutes to warm up. From their time at the facility, S1, S2, S3, S4, and S5 stated there were no hot water issues in the facility to their knowledge. R1, R2, R3, R4, and R5 stated there have not been any issues with the hot water in their showers and bathroom sink during their time at the facility.

Based on record reviews, LPA examined the water log temperature dated from July 6, 2025, to August 13, 2025, where the water temperature never fell below 105.0 Degrees F or above 120 degrees F.

Based on observations, interviews, and records review, LPA did not find sufficient evidence to support the above allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview was conducted, and a copy of the report was provided to Executive Director Austin Morris.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025

LIC9099 (FAS) - (06/04)

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