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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300600977
Report Date: 12/26/2024
Date Signed: 12/26/2024 04:37:36 PM

Unfounded


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
12/19/2024 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20241219150833
FACILITY NAME:TOWN & COUNTRYFACILITY NUMBER:
300600977
ADMINISTRATOR:SARA MODUGNOFACILITY TYPE:
741
ADDRESS:555 E. MEMORY LANETELEPHONE:
(714) 547-7581
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:328CENSUS: 102DATE:
12/26/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Cristina Garcia, LVN TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility did not ensure that it was free of pests
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint visit. LPA Mendivil was greeted and granted entry by Sammantha Meza, Liason and Crisitina Garcia, LVN explained the reason for the visit. Head Chef Pedro Miranda arrived shortly after.

The Department received a complaint on 12/19/2024 and the initial investigation conducted on 12/26/2024. LPA Mendivil toured the facility and interviewed staff and residents. Regarding the allegation facility did not ensure that it was free of pests, the invesitgation revealed the following:

It was alleged that in the Independent Living dining room there were pests present. LPA Mendivil toured the facility on 12/17/2024 for an annual visit and did not observe pests or rodents. LPA Mendivil toured Independent Living dinning room again on 12/26/2024 with Head Chef Pedro Miranda and Sous Chef Anthony Montes. LPA Mendivil observed staff cleaning the kitchen between meal services. LPA Mendivil observed a cleaning log.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
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-20241219150833
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: TOWN & COUNTRY
FACILITY NUMBER: 300600977
VISIT DATE: 12/26/2024
NARRATIVE
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LPA Mendivil observed Public Health Services "Retail Food Facility Inspection Report" dated 06/12/2024 which the facility passed. Based on interviews with 3 out of 3 residents stated they have not seen any pest or rodents in the facility. Residents stated if they noticed any issues they would reach out to housekeeping or notify the front desk. Based on interviews with 6 out 6 staff deny the allegation that facility is not kept free of pests.

Therefore based on the preponderance of evidence through observations and interviews the allegation that Facility did not ensure that it was free of pests is determined to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint.
No deficiencies cited.

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: 12/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2