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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003656
Report Date: 01/29/2026
Date Signed: 01/29/2026 03:20:43 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
01/27/2026 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260127083506
FACILITY NAME:TESSIE'S PLACE LOVING CARE HOME #3FACILITY NUMBER:
306003656
ADMINISTRATOR:ROMUALDO AMANTEFACILITY TYPE:
740
ADDRESS:26551 ROYALE DRIVETELEPHONE:
(949) 481-0912
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:6CENSUS: 4DATE:
01/29/2026
UNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Romualdo AmanteTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff abandoned resident at the hospital.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Administrator Romualdo Amante and explained the reason for the visit. The investigation into the allegation revealed the following. Resident 1 (R1) moved into the facility on January 21, 2026 after being discharged from Kaiser Permanente hospital. On January 22, 2026 R1 moved into the facility and later that day R1 hit a staff member and called 911. Staff reported that the Sheriff arrived and called an ambulance to take R1 to the hospital. R1 was admitted to Mission Hospital for an evaluation. On January 26, 2026, R1 was cleared by the hospital to be returned to the facility. It was reported that the facility initially agreed to take R1 back but then reported to the hospital that due to R1's aggressive behavior they would not take R1 back. The Licensee reported that they went to the hospital to speak to R1 on January 27 and they agreed to take R1 back to the facility. R1 reported that they were told initially by the hospital that they could return to the facility but then was told by the facility staff and hospital that they could not return to the facility. R1 reported that the facility informed them that they could return but they had already made arrangements to move to a new facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
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 3
Control Number 22-AS-20260127083506
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: TESSIE'S PLACE LOVING CARE HOME #3
FACILITY NUMBER: 306003656
VISIT DATE: 01/29/2026
NARRATIVE
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The Licensee reported R1 informed them they did not want to return to the facility. The Administrator reported that they didn't want R1 to return due to safety concerns to staff and residents but then informed the hospital they would take R1 back if they wanted to move back to the facility. R1 reported that after she was informed the facility would not take her back she found a new place to live. Based on the evidence gathered, the preponderance of evidence standard has been met, therefore, the allegation is substantiated. Violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted with the Administrator and a copy of this report provided along with the citation and Appeal Rights.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260127083506
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: TESSIE'S PLACE LOVING CARE HOME #3
FACILITY NUMBER: 306003656
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/30/2026
Section Cited
CCR
87224(a)
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Eviction Procedures - The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty days written notice to the resident is required...This requirement was not met as evidenced by:
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Licensee agrees to review and comply with regulation 87224 Eviction Procedures. Licensee to submit a statement of understanding regulation 87224. Licensee agrees that 30 day eviction notice will be issued before a resident is evicted. Licensee to submit proof of correction to LPA by POC due date 1/30/2026.
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Based on interviews the facility did not take R1 back from the Hospital when they were cleared to be released. The licensee did not serve R1 with a 30 day notice to evict. This poses an immediate Health and Safety and/or Personal Rights risk to 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: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3