306005196-3-25-2026-22-AS-APAO-DSKAW7-20260327003436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005196
Report Date: 03/25/2026
Date Signed: 03/25/2026 02:59:47 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
01/08/2026 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260108144042

FACILITY NAME:	CASA DEL SOL		FACILITY NUMBER:	306005196
ADMINISTRATOR:	MENDOZA, IRVIN		FACILITY TYPE:	740
ADDRESS:	6486 EAST CALLE DEL NORTE		TELEPHONE:	(714) 602-8234
CITY:	ANAHEIM HILLS	STATE: CA	ZIP CODE:	92807
CAPACITY:	6	CENSUS: 4	DATE:	03/25/2026
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Irvin Mendoza- Administrator		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Staff did not seek medical attention for resident in care in a timely manner.

INVESTIGATION FINDINGS:

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On 3/25/2026, Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of continuing the investigation into the above allegation. LPA notified Director/Administrator Daniel Rescia by telephone and explained the reason for the visit. Administrator Irvin Mendoza arrived on premise on behalf of Director Rescia and remained throughout the visit. On January 8, 2026, the Department received the complaint. The complaint was initiated by LPA on January 12, 2026. During the course of the investigation, LPA interviewed two of four residents as the remaining two residents were unable to provide a statement due to their medical condition. LPA also interviewed three staff, four witnesses, and obtained the following documentation for review: Resident Rosters, Staff Roster, Face Sheets and Physician's Reports for all residents including Resident #1 (R1) as well as R1's Admission Agreement, Needs and Services Plan, Care Notes, and medical records.

The investigation is as follows: It is alleged that Staff did not seek medical attention for resident in care in a timely manner.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

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 4

Control Number 22-AS-20260108144042

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: CASA DEL SOL	FACILITY NUMBER: 306005196
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/25/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/26/2026 Section Cited CCR 87465(g)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Admin Mendoza stated and agreed to forward proof of an in-service training reviewing PIN 25-06-AC and placing 911 calls in the event of an incident/emergency for hospice residents and an Acknowledgement of Understanding of the said deficiency will be submitted to LPA by POC due date.
	8 9 10 11 12 13 14	Based on interviews and record review, S1 observed swelling of the leg 2 days after the fall delaying the need for medical attention which poses an immediate Health, Safety, and/or Personal Rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 22-AS-20260108144042

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: CASA DEL SOL	FACILITY NUMBER: 306005196
	VISIT DATE: 03/25/2026

NARRATIVE

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R1 suffered an unwitnessed fall on December 24, 2025 at 4:30am per the incident report dated December 26, 2025. Staff #1 (S1) discovered R1 on the floor calling for help while on their way to use the bathroom. Based on the admission agreement signed by R1 on April 3, 2024, page 2 of the admission agreement states that the facility does not provide a 24-hour awake staff, however staff would be on site in case of an emergency. Upon S1's initial assessment, there were no visible injuries, so S1 safely transferred R1 back to bed. The same day at 7:59am, S1 reported the fall to Staff #2 (S2) via text message. S1 subsequently reported the fall to hospice the same day approximately 9am per the incident report where S1 was advised to administer Tylenol for pain. On December 25th approximately 11am, R1 began complaining of left foot pain per the incident report. Hospice staff arrived to assess R1 and placed an order for a mobile X-ray. On December 26th, the X-ray technician arrived approximately 3:45pm to obtain X-rays. The X-ray results dated December 26th at 3:13pm indicated displaced partially impacted inter/subtrochanteric fracture with varus deformity, femoral diaphysis intact, right hip fracture. Hospice contacted R1's representative, and a decision was made to send R1 to the emergency room for further evaluation and treatment. Based on the interviews, one of three staff confirmed R1 expressed pain the day of the fall evidenced by groaning, however the two remaining staff denied R1 was in pain the day of the fall. It was not until December 26th when S1 observed R1's leg swelling when hospice staff alerted S1 prior to R1's shower approximately 8-9am.

The investigation revealed that facility staff failed to immediately notify hospice after the fall which was discovered approximately 4:30am. S1 reported to S2, their direct supervisor, approximately 3.5 hours later after the fall, and an hour later to hospice. Although there were no visible injuries per the statement of three of three staff; it was not until two days later, December 26th, where visible changes to the leg was observed where R1's leg became swollen approximately 8:30am per S1. At this point, it was the responsibility of the facility to seek emergency medical attention prior to the X-ray technician arriving. Per the Department's Provider Information Notice (PIN) 25-06-ASC released on June 24, 2025, the PIN outlines protocols in Residential Care for the Elderly (RCFEs) when emergency services may be necessary and to help ensure residents receive timely medical care. The PIN indicates that the licensee shall immediately place a 9-1-1 call if a resident is experiencing any "imminent threat" and any symptoms which includes "falls with complaints of pain or loss of range of motion" or "obvious broken bones" which caused R1's leg to swell that facility failed to do.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 22-AS-20260108144042

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: CASA DEL SOL	FACILITY NUMBER: 306005196
	VISIT DATE: 03/25/2026

NARRATIVE

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Therefore, based on interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Staff did not seek medical attention for resident in care in a timely manner is deemed SUBSTANTIATED. A deficiency is being cited on the attached LIC9099-D.

An exit interview was conducted with Administrator Irvin Mendoza, and a copy of this report including the appeal rights and Confidential Names (LIC 811) were provided at exit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

LIC9099 (FAS) - (06/04)

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