<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004826
Report Date: 02/20/2025
Date Signed: 02/20/2025 03:09:39 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
02/06/2025 and conducted by Evaluator RoseMarie Ruppert
COMPLAINT CONTROL NUMBER: 22-AS-20250206160830
FACILITY NAME:ORANGEWOOD GUEST HOMEFACILITY NUMBER:
306004826
ADMINISTRATOR:MEL CARBAJAL MIN FAJARDOFACILITY TYPE:
740
ADDRESS:1598 W. ORANGEWOOD AVE.TELEPHONE:
(714) 583-8965
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:6CENSUS: 5DATE:
02/20/2025
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Melissa Carbajal and Mindy Fajardo, AdministratorsTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff yelled at client
Staff attempted to hit a client
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to deliver findings for a complaint received in our Regional Office on February 6, 2025. LPA was greeted and granted entry and explained the purpose of the visit. LPA met with both Administrators, Melissa Carbajal and Mindy Fajardo.

A report was filed with our office where a vendor witnessed a facility staff member, who yelled at the client and attempted to hit the client. On February 5, 2025, at 7:50am, the client was being picked up for Day Program when the incident occurred. Based on LPA interviews with the eyewitness and two of two staff present in facility at time of incident, Staff #1 (S1) had reached for the client’s backpack and the client grabbed S1’s hand. Client is non-verbal and indicated she wanted the backpack on her back. S1 raised her voice to the client to, “Let go” and client complied. According to the two of two staff members and eyewitness, the incident was brief. The staff member, S1, then placed the back pack on client’s shoulders and the client left for Day Program.
(Continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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-20250206160830
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: ORANGEWOOD GUEST HOME
FACILITY NUMBER: 306004826
VISIT DATE: 02/20/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Continued from LIC 9099)

LPA interviewed four of four staff; including S1, the staff member directly involved, who all denied the allegations. LPA spoke with two clients, one involved in the incident, who is non-verbal, and the other, a verbal client. The verbal client stated the staff member does not yell at them and has never tried to hit residents. LPA engaged with the non-verbal client who smiled at LPA. LPA observed client to be oriented to time and place and used body language, such as hand gestures and nodding. Client understands questions asked by LPA and staff. When asked about staff member, S1, LPA observed the client to be relaxed, nodding head up and down and smiling.

Documents obtained and reviewed include the Client’s: Identification and Emergency Information, Physician’s Report and Appraisal/ Needs and Services Plan. Additional documents obtained include the Register of Facility Clients and the facility sign-in/sign-out sheet; signed by the vendor on the day of the incident. Upon file review client is prone to have aggressive incidents per Individual Program Plan (IPP) dated February 24, 2024. LPA reviewed Staff #1’s file and there were no disciplinary actions on record. S1's staff training included Elder Abuse and mandated reporting from July 7, 2024.

Two staff members were interviewed from the Day Program, who reported the allegations. The eyewitness stated the yelling, by S1, was not shouting, but a raised voice. The eyewitness stated S1 moved her hand from side-to-side, as if to swat the client’s hands. Eyewitness stated staff member raised her hand to client’s face and, again, moved her hand from side-to-side. No contact was made. Eyewitness stated S1 spoke to client, “Like a parent addressing a toddler” which witness felt was not professional.

LPA spoke with the Regional Center of Orange County (RCOC) Quality Assurance Coordinator (QAC), who had also visited the facility on February 11, 2025. The RCOC QAC’s findings were inconclusive.

A 9102-TV has been issued to request staff training on recognizing and mitigating client behaviors, as well as documenting behavioral incidents in client’s file.

Although the above allegations may have happened there is not a preponderance of evidence to prove the alleged violations occurred; therefore, the allegations that: staff yelled at client and that staff attempted to hit client is unsubstantiated.

An exit interview was conducted with Melissa Carbajal and Mindy Fajardo, Administrators, and a copy of this report and LIC 9102-TV was provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2