306005218-1-29-2026-22-AS-APAO-DR88BK-20260211212227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005218
Report Date: 01/29/2026
Date Signed: 01/29/2026 04:10:28 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
02/02/2021 and conducted by Evaluator Fred Arias

COMPLAINT CONTROL NUMBER: 22-AS-20210202163808

FACILITY NAME:	AGAPE ORANGE HOME		FACILITY NUMBER:	306005218
ADMINISTRATOR:	SURGENT, NATALIA		FACILITY TYPE:	740
ADDRESS:	816 E MEATS AVE		TELEPHONE:	(714) 366-1858
CITY:	ORANGE	STATE: CA	ZIP CODE:	92865
CAPACITY:	6	CENSUS: 6	DATE:	01/29/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Andreea Moldovan		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Staff asked resident inappropriate question(s).
Staff left resident in soiled clothing for an extended period of time.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.

It was alleged staff asked resident inappropriate questions and staff left resident in soiled clothing for an extended period of time. During the investigation, LPA conducted interviews with staff and residents in care. LPA reviewed records obtained.

The investigation determined as follows: Regarding the allegation staff asked resident inappropriate questions, it was reported a staff member had asked Resident 1 (R1) if they wanted lotion to be rubbed in their private parts. LPA interviews with seven out of seven current and former staff stated that they have never witnessed or were made aware of any inappropriate conversations with residents. Five out of seven current and former staff stated R1 had a history of psychotic episodes and would act out aggressively towards staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
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)

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Control Number 22-AS-20210202163808

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: AGAPE ORANGE HOME	FACILITY NUMBER: 306005218
	VISIT DATE: 01/29/2026

NARRATIVE

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Four out of the five former and current staff added R1 punched a staff member while the staff member was assisting with a shower. Administrator AD Andreea Moldovan stated R1 moved away from the facility October of 2023. Interviews with two out of six residents stated their needs are being met and have never been spoken to inappropriately by staff. The remaining residents could not be qualified for interviews. Record review revealed R1 was diagnosed with a schizoaffective disorder and a mild cognitive impairment. Four out of four current staff have completed personal rights training. Three out of four current staff have signed mandated reporter acknowledgements.

Regarding the allegation staff left resident in soiled clothing for an extended period of time, it was reported R1 was left soiled in a diaper for a period of time. Interviews with five out of seven former and current staff stated residents are checked for incontinence care needs two to three times per shift or more as needed. One out of those five staff stated R1 was able to communicate their needs when needing to use the bathroom. The remaining two staff did not add anything relevant to this allegation. Interviews with two out of six residents stated they get assistance with incontinence care. The remaining four residents could not be qualified for interviews. Record review revealed R1's physician report stated R1 could communicate needs.

Based on resident interviews, staff interviews and records observed, the allegations of staff asked resident inappropriate questions and staff left resident in soiled clothing for an extended period of time are therefore deemed unsubstantiated meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and a copy of the report was left with the facility representative.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
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)

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