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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336423521
Report Date: 03/08/2023
Date Signed: 06/27/2025 08:59:34 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/11/2022 and conducted by Evaluator Amy Goldenberg
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220411105654
FACILITY NAME:ABBEY ELDER CARE, INC.FACILITY NUMBER:
336423521
ADMINISTRATOR:SUNDEEP RANDHAWAFACILITY TYPE:
740
ADDRESS:3412 WEXFORD CIRCLETELEPHONE:
(951) 858-8641
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:6CENSUS: 5DATE:
03/08/2023
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:TIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Staff left residents unattended
Staff failed to meet resident's needs
INVESTIGATION FINDINGS:
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 On 6/27/2025, Licensing Program Analyst (LPA) Mary Rico mailed a certificated letter to deliver the findings on the allegation listed above.

For the allegation, Staff left residents unattended. During staff interviews 3 out of the 3 staff stated they have not left a resident unattended at the facility. Furthermore, for the allegation staff failed to meet resident's needs, 3 out of the 3 staff stated they would meet residents’ needs by providing assistance with their ADLS.
Based on the evidence found during the investigation, the two (2) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means 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. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. A copy of this report was mailed to facility’s designated mailing address.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/11/2022 and conducted by Evaluator Amy Goldenberg
COMPLAINT CONTROL NUMBER: 56-AS-20220411105654

FACILITY NAME:ABBEY ELDER CARE, INC.FACILITY NUMBER:
336423521
ADMINISTRATOR:SUNDEEP RANDHAWAFACILITY TYPE:
740
ADDRESS:3412 WEXFORD CIRCLETELEPHONE:
(951) 858-8641
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:6CENSUS: 5DATE:
03/08/2023
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Olive Ochoa, CaregiverTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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2
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9
Staff failed to provide adequate food service
INVESTIGATION FINDINGS:
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This unannounced visit conducted by Amy Goldenberg and Rayshaun Nickolas, Licensing Program Analysts (LPAs), is being conducted to conclude investigation of the above-mentioned complaint allegation.

It is alleged that the facility only serves only corn dogs and pizza to R1. Investigation consisted of review of the food supply and menu. LPA review of the food supply did not reveal substantiation that only frozen foods are being provided. LPA reviewed menues and food stores on 4/14/2022 and 3/8/2023. LPA observed that on these dates the facility is meeting the requirement of available nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. LPA observes fresh fruits and vegetables, milk, juice, frozen meats, breads, pastas, rice, and a variety of pantry items and condiments. We have found the complaint allegation is unsubstantiated, although the allegation may have happened or is valid: there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 56-AS-20220411105654
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: ABBEY ELDER CARE, INC.
FACILITY NUMBER: 336423521
VISIT DATE: 03/08/2023
NARRATIVE
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R2 was observed wandering the facility during LPA visit on 04/14/2022. Review of R2's record indicate diagnosis requiring supervision and dementia regulations in place. The front door alarm was turned off at the time of LPA visit on 04/14/2022. LPA observed one caregiver on duty on this date (S3) which was not monitoring R2 or R1 at the time of LPA arrival. The caregiver is responsible to provide all care and supervision to residents, cook meals, clean and do laundry. Based on the aforementioned this agency has determined that the preponderance of available evidence indicates that the facility was inadequately staffed leaving residents unattended and unable to meet residents needs.

We have substantiated the complaint allegations as valid and that a violation has occurred based on the preponderance of available evidence. A copy of this report along with appeal rights are being reviewed with, and furnished to the facility representative. Please see LIC 9099D
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20220411105654
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: ABBEY ELDER CARE, INC.
FACILITY NUMBER: 336423521
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/08/2023
Section Cited
CCR
87411(a)
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Personnel Requirements: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Based on review of the records and interviews with staff
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Licensee to review 87411(a) and provide LIC9098 indicating understanding of the requirement by POC due date.
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 and LPA observations R1 and R2 required more care and supervision than what was being provided. This poses a risk to the health and safety of residents in care.
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* A Civil Penalty Assessment accompanies this dificiency as this is a repeat violation.
Type A
03/09/2023
Section Cited
CCR
87464(d)
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 A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs...
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Licensee to review 87464(d) and provide LIC9098 indicating understanding of the requirement by POC due date.
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Based on review ofresident records R1 and R2 required more care and supervision than what was being provided. This poses a risk to the health and safety of residents in care.
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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: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4