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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003421
Report Date: 04/21/2026
Date Signed: 04/21/2026 10:54:11 AM

Unsubstantiated


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
10/07/2024 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 22-AS-20241007121130
FACILITY NAME:SOUTH HOME CAREFACILITY NUMBER:
306003421
ADMINISTRATOR:ADELA ALBUFACILITY TYPE:
740
ADDRESS:2779 E. DIANA AVENUETELEPHONE:
(714) 630-5744
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY:6CENSUS: DATE:
04/21/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Adela AlbuTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff are not addressing resident's fall risk while in care.
Staff did not seek medical attention in a timely manner.
Facility did not meet reporting requirements.
Staff are not providing adequate food service to residents in care.
INVESTIGATION FINDINGS:
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On 04/21/2026, Licensing Program Analyst (LPA) Cassandra Mikkelson contacted the licensee via email to deliver final findings regarding a complaint that was received on 10/07/2024.

Continued on 9099C page
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
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-20241007121130
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: SOUTH HOME CARE
FACILITY NUMBER: 306003421
VISIT DATE: 04/21/2026
NARRATIVE
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Staff are not addressing resident's fall risk while in care.

Interviews conducted indicated that staff knew that Resident R1 was a fall risk and tried to prevent falls best they could. R1 continued to try and keep their independence and get up on their own which resulted in occasional falls. Staff were able to help R1 ambulate by using a walker or pushing R1 in a wheelchair. Therefore, the allegation staff are not addressing resident’s fall risk while in care is unsubstantiated.

Staff did not seek medical attention in a timely manner.

Interviews conducted indicated that staff were quick to assist residents in care. 911 was called when needed although at times there might have been a delay in communication causing 911 to be delayed for a short time. Interviews with residents indicated that they have call buttons accessible to them and staff will answer and assist when the button is pushed. Therefore, the allegation staff did not seek medical attention in a timely manner is unsubstantiated.

Facility did not meet reporting requirements.

Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated.

Staff are not providing adequate food service to residents in care.

Interviews with residents indicated that food service was good and there was no complaints. Observations indicated that healthy meals were being provided to residents. Therefore, the allegation staff are not providing adequate food service to residents in care is unsubstantiated.

Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
LIC9099 (FAS) - (06/04)
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