306006736-7-24-2026-22-AS-AORZ-DWQVYJ-20260807165109

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006736
Report Date: 07/24/2026
Date Signed: 07/24/2026 12:54:56 PM

Unsubstantiated

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
07/20/2026 and conducted by Evaluator Andrea Mendivil

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260720095305

FACILITY NAME:	GROVES OF TUSTIN, THE		FACILITY NUMBER:	306006736
ADMINISTRATOR:	RUIZ HIDALGO, SUSAN		FACILITY TYPE:	740
ADDRESS:	1262 BRYAN AVENUE		TELEPHONE:	(714) 627-5947
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	100	CENSUS: 69	DATE:	07/24/2026
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Alma Gomez - Memory Care Director		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff yelled at resident
Staff do not provide resident with protein drink.
Staff does not follow food menu for residents.

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

The Department received a complaint on July 20, 2026 and the Department conducted an initial 10 day visit. LPA Mendivil obtained copies of facility menus, resident physician's orders, physician's report and care plan as well as interviewed staff and residents. Regarding the allegations staff yelled at resident, staff do not provide resident with protein drink and staff does not follow food menu for residents, the investigation revealed the following:

Per review of Resident 1 (R1) physician's report dated October 15, 2025 reported that R1 has a diagnosis hypertension, hypothyriod, chronic low back pain, and chronic kidney disease. It was alleged that staff yelled at R1. Per interviews with 4 out of 4 residnets stated staff has not yelled at them.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026

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-20260720095305

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: GROVES OF TUSTIN, THE	FACILITY NUMBER: 306006736
	VISIT DATE: 07/24/2026

NARRATIVE

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Per interviews with 5 out of 5 staff interviewed, staff denies ever yelling at R1 or any resident.

It was alleged that staff do not provide a resident protein drink. Per review of R1's physician's orders there is no order for protein shakes or nutritional supplements. Per interview with Memory Care Director (MCD) Alma Gomez, it was stated the nutritional shakes are stored in the facility kitchen and available upon request.

It was alleged that staff does not follow food menu for residents. Per interview with MCD staff follows menu unless an item was not available through Sysco which then the menu would be updated. MCD stated the front desk has a copy of daily menus available. Per MCD the facility is currently in the process of hiring a new Culinary Services Director . MCD stated core kitchen staff is the same and trained. MCD stated she is doing the ordering and logistics of the kitchen. MCD stated that there is an "always available" menu for residents. Interviews with 4 out of 4 residents, the residents stated the food was good and they did not have any complaints.

Therefore based on the preponderance of evidence through records reviewed and interviews the allegations the allegations Staff yelled at resident , Staff do not provide resident with protein drink, Staff does not follow food menu for residents are determined to be UNSUBSTANTIATED, meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026

LIC9099 (FAS) - (06/04)

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