306006584-3-18-2026-22-AS-APAO-DSB7P5-20260318214947

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006584
Report Date: 03/18/2026
Date Signed: 03/18/2026 01:14:14 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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 Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20260114091113

FACILITY NAME:	SEVILLE OF SAN CLEMENTE, THE		FACILITY NUMBER:	306006584
ADMINISTRATOR:	ENDERT, ROGER		FACILITY TYPE:	740
ADDRESS:	2421 CALLE FRONTERA		TELEPHONE:	(760) 382-3463
CITY:	SAN CLEMENTE	STATE: CA	ZIP CODE:	92673
CAPACITY:	130	CENSUS: 70	DATE:	03/18/2026
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Heather O'Neill, Roger Endert and Jessica Hong		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Lack of supervision resulted in resident being left outside
Facility did not notify resident's responsible party of change in resident's reappraisal

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility and interviewed staff and witnesses. Regarding the allegations that lack of supervision resulted in resident being left outside and facility did not notify resident's responsible party of change in resident's reappraisal, the investigation revealed the following: On 01/13/2026, Resident 1 (R1) was observed by Staff 1 (S1) outside on a front patio at approximately 6:05 AM in pajamas. R1 was unable to get back inside the facility due to a key fob being necessary as doors are locked in the overnight hours. S1 was coming into work when the resident was observed outside. Resident was determined to be ice cold but no injuries noted. Resident's room is located in the rear of the building and there are no staff at the front desk during overnight hours. It has not been determined how long the resident was outside. R1 was reassessed December 2, 2025. Responsible party indicates not being informed of the changes. CONTINUED ON LIC 9099C DATED 03/18/2026

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

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-20260114091113

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SEVILLE OF SAN CLEMENTE, THE	FACILITY NUMBER: 306006584
	VISIT DATE: 03/18/2026

NARRATIVE

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Facility documentation obtained confirms that the responsible party was not informed of the changes nor signed the plan dated 12/02/2025 at time of implementation. Based on interviews conducted and record review, the allegations are determined to be SUBSTANTIATED, meaning the complaint allegations are valid and violations have occurred.
The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8.
An exit interview was conducted and a copy of this report and appeal rights was provided to the facility representative.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20260114091113

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SEVILLE OF SAN CLEMENTE, THE	FACILITY NUMBER: 306006584
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/18/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/19/2026 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee to forward a detailed plan as to how to ensure the saftey of residents overnight and forward proof to LPA by POC due date.
	8 9 10 11 12 13 14	Based on interviews conducted, Licensee failed to ensure care and supervision was provided to resident. R1 was locked outside on a patio in the early morning hours which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
Type B 04/01/2026 Section Cited HSC 1569.657(a)	1 2 3 4 5 6 7	For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative.., written notice of the rate increase within two business days after initially providing services at the new level of care. This req is not met as evidenced by:	1 2 3 4 5 6 7	Licensee to submit a plan to ensure responsible parties are notified of rate increases timely and forward proof to LPA by POC due date.
	8 9 10 11 12 13 14	Based on interviews conducted and record review, Licensee did not provide written notice to responsible party of increase in fees. This poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14

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

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

LIC9099 (FAS) - (06/04)

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