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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300611895
Report Date: 06/16/2025
Date Signed: 06/16/2025 02:57:00 PM

Substantiated


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
03/03/2025 and conducted by Evaluator Hanna Gough
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250303123024
FACILITY NAME:ROBIN'S NEST, THEFACILITY NUMBER:
300611895
ADMINISTRATOR:MARTHA CRAWFORDFACILITY TYPE:
740
ADDRESS:2051 S. DELLA LANETELEPHONE:
(714) 530-9587
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:6CENSUS: 3DATE:
06/16/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Martha CrawfordTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility staff did not provide resident reappraisal upon change in condition
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hanna Gough made an unannounced inspection for the purpose of investigating the above mentioned complaint allegation. LPA was greeted and granted entry and met with Administrator (AD) Martha Crawford and discussed the purpose of the visit.

The investigation into the allegation facility staff did not provide resident reappraisal upon change in condition revealed the following: During the course of the investigation, the department interviewed the responsible party, staff and residents in care. During interviews with Staff (S1) it was revealed that on December 28th, 2024, Resident 1(R1) sustained a fall and was sent to the hospital. S1 informed the department that there is a clause in the admission agreement for a rate increase if there is a change in condition for R1. S1 informed the department that they were planning to update R1 needs and services plan. Upon record review, it was revealed that the last appraisal was updated on February 15, 2020 and the last needs and services plan was updated on March 1, 2020.
Continue on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
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 5
Control Number 22-AS-20250303123024
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: ROBIN'S NEST, THE
FACILITY NUMBER: 300611895
VISIT DATE: 06/16/2025
NARRATIVE
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Based on LPAs observations, interviews and information gathered during the investigation and review of all documents obtained, the preponderance of evidence standard has been met, therefore the above allegation is deemed SUBSTANTIATED. California Code of Regulations, Title 22 Division 6 is being cited on the attached LIC 9099D.

An exit interview was conducted with AD Martha Crawford and a copy of this report along with LIC 9099D and appeal rights were given at the time of inspection.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 22-AS-20250303123024
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: ROBIN'S NEST, THE
FACILITY NUMBER: 300611895
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2025
Section Cited
CCR
87463(a)
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Reappraisals 87463(a)
The pre-admission appraisal...Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition...
This requirement is not met as evidence by:
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Licensee stated they will update R1s appraisals and send to LPA by POC due date.
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Based on record review, R1s last appraisal was dated February 15, 2020 and last needs and services was dated March 1, 2020. This poses a potential risk to resident's health and safety 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: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
03/03/2025 and conducted by Evaluator Hanna Gough
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250303123024

FACILITY NAME:ROBIN'S NEST, THEFACILITY NUMBER:
300611895
ADMINISTRATOR:MARTHA CRAWFORDFACILITY TYPE:
740
ADDRESS:2051 S. DELLA LANETELEPHONE:
(714) 530-9587
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:6CENSUS: 3DATE:
06/16/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Martha CrawfordTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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2
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Facility did not report unwitnessed falls to authorized representative
Facility staff did not seek timely medical attention for resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hanna Gough made an unannounced inspection for the purpose of investigating the above mentioned complaint allegations. LPA was greeted and granted entry and met with Administrator (AD) Martha Crawford and discussed the purpose of the visit.

The investigation into the allegations that the facility did not report unwitnessed falls to authorized representative and facility staff did not seek timely medical attention for resident revealed the following: During the course of the investigation, the department interviewed the responsible party, staff and residents in care. During interviews it was revealed that 3 of 3 residents felt as if the staff had good communication with their families. Resident #1(R1) informed the department that the staff respond very well when medical assistance is needed. R1 was sure the facility contacted their family when they had their fall on December 28th, 2024. During interviews with Staff1 (1) it was revealed that a text message was sent on December 28th, 2024 by S1 at 4:28PM informing R1s responsible party of R1s fall.
Continue on 9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20250303123024
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: ROBIN'S NEST, THE
FACILITY NUMBER: 300611895
VISIT DATE: 06/16/2025
NARRATIVE
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The text message was sent on December 28, 2024, the same day as the reported fall. The text message also revealed that on December 28th, 2024 S1 informed R1s responsible party that they contacted ambulatory services and that R1 was being transported to the hospital. S1 informed LPA that the fall happened around 3pm ambulatory services came after 3pm and then they informed R1s responsible party while the paramedics were here via text message at 4:28PM.

Based on LPAs observations, interviews and information gathered during the investigation and review of all documents obtained, the preponderance of evidence standard has not been met, therefore the above allegations are deemed UNFOUNDED. Meaning that the allegations facility did not report unwitnessed falls to authorized representative and facility staff did not seek timely medical attention for resident was false, could not have happened and/or is without a reasonable basis. The department therefore dismissed the complaint.

An exit interview was conducted with AD Martha Crawford and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5