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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004749
Report Date: 11/12/2025
Date Signed: 11/12/2025 04:35:50 PM

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
09/15/2023 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230915142119
FACILITY NAME:ACACIA VILLASFACILITY NUMBER:
306004749
ADMINISTRATOR:TAMMY JOOFACILITY TYPE:
740
ADDRESS:1620 E. CHAPMAN AVENUETELEPHONE:
(714) 879-0920
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:99CENSUS: 98DATE:
11/12/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Executive Director Tammy JooTIME COMPLETED:
04:55 PM
ALLEGATION(S):
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Staff did not prevent a resident from falling multiple times while in care
INVESTIGATION FINDINGS:
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On November 12, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to continue the investigation into the allegation listed above and to deliver the complaint findings. LPA was greeted and granted entry into the facility by Executive Director (ED) Tammy Joo after explaining the purpose for the visit.

The initial complaint visit was conducted on September 22, 2023, in which resident and staff interviews were conducted, and pertinent documents to the complaint were collected. On today's visit, additional residents and staff interviews were conducted.

Regarding the allegation that, staff did not prevent a resident from falling multiple times while in care, the following has been concluded: Resident #1 (R1) was admitted to the facility on December 19, 2022. Per R1's Physician Report dated November 18, 2022, R1 was diagnosed with Mild Cognitive Impairment. R1 was non-ambulatory; able to communicate his needs; able to follow instructions; but was confused/disoriented at times. CONTINUED ON LIC9099-C
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2025
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 2
Control Number 22-AS-20230915142119
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: ACACIA VILLAS
FACILITY NUMBER: 306004749
VISIT DATE: 11/12/2025
NARRATIVE
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Per the Unusual Incident/Injury reports (UIIRs) received by the Orange County Regional Office, R1 had a total of three falls while at the facility. R1 had one fall on September 12, 2023, one fall on September 13, 2023, and had one fall on September 14, 2023. R1 was transported to the hospital after sustaining the fall on September 14, 2023, and was admitted for increasing weakness and multiple falls. Based on a review of the hospital records, R1 did not sustain any injuries as a result of the three falls. The Department conducted an interview with R1 for this complaint but R1 was unable to provide any useful information regarding the allegation. The Department also attempted to conduct an interview with R1's Responsibly Party but were unable to due to the Department being unable to reach them. The Department conducted a total of seven staff interviews. Four out of the seven staff interviewed were unable to provide any useful information regarding the allegation due to staff not recalling the incidents. Three out of the seven staff interviewed stated that increased checks were done on R1 after the first fall to try and prevent any future falls. Staff interviews conducted stated that changes to R1's apartment were recommended to R1's family to prevent future falls, however, R1's family declined the recommended changes. Staff interviews conducted also revealed that the care plan for R1 was unable to be updated to require a higher level of care for being a fall risk, due to R1 not returning to the facility after sustaining the fall on September 14, 2023.

Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with Executive Director Tammy Joo and a copy of the report was provided.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2025
LIC9099 (FAS) - (06/04)
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