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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006488
Report Date: 05/15/2026
Date Signed: 05/15/2026 10:34:10 AM

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
01/14/2026 and conducted by Evaluator Hanna Gough
COMPLAINT CONTROL NUMBER: 22-AS-20260114150950
FACILITY NAME:PACIFIC BOARD AND CARE HOMEFACILITY NUMBER:
306006488
ADMINISTRATOR:HERNANDEZ, DIANAFACILITY TYPE:
735
ADDRESS:7612 PACIFIC AVENUETELEPHONE:
(714) 266-0194
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:6CENSUS: 5DATE:
05/15/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Maria MendozaTIME COMPLETED:
10:50 AM
ALLEGATION(S):
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Staff handled client in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility to conduct an investigation into the above mentioned complaint allegation. LPA contacted Administrator Diana Hernandez to discuss the purpose of the visit via phone due to no answer at the facility door. LPA was greeted and granted entry by Direct Support Professional (DSP) Maria Mendoza and discussed the purpose of the visit.

The investigation into the facility allegation of staff handled client in a rough manner revealed the following: it was alleged that Staff #1 (S1) held Client #1 (C1) by the arm tightly during dinner time. LPA reviewed C1s physicians report dated November 11, 2025, that states that C1 has no problem with communicating their needs. LPA reviewed an Individual Program Plan for C1 dated April 17, 2025, stating that C1 was able to communicate their needs in 3-4 word sentences.

During interviews it was revealed that C1 no longer resides at the facility and LPA was unable to interview C1.

Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026
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 2
Control Number 22-AS-20260114150950
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: PACIFIC BOARD AND CARE HOME
FACILITY NUMBER: 306006488
VISIT DATE: 05/15/2026
NARRATIVE
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LPA was unable to interview C1s responsible party.

LPA interviewed 4 of 5 current clients in care and 4 of 5 clients denied S1 being rough with them and denied seeing S1 being rough with C1. 4 of 5 clients informed LPA that facility staff has never hurt them physically.

LPA interviewed staff and 4 of 4 staff denied the allegation including S1. 4 of 4 staff informed LPA that C1 had aggressive behaviors. 3 of 4 staff have informed LPA that they have never hit clients in care or been rough with them.

Based on information gathered and interviews conducted, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2