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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005231
Report Date: 01/16/2026
Date Signed: 01/16/2026 01:15:08 PM

Unfounded


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
01/14/2026 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260114162139
FACILITY NAME:GRAND VIEW VILLAFACILITY NUMBER:
306005231
ADMINISTRATOR:AMNALI, ROZINAFACILITY TYPE:
740
ADDRESS:26701 GRANVIA DRIVETELEPHONE:
(949) 600-7218
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
01/16/2026
UNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:Rozina Amlani, administratorTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Staff did not seek timely medical attention for resident.

Staff did not ensure resident was adequately fed and hydrated.
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the two allegations listed above. LPA was greeted and granted entry by caregiving staff after introducing himself and stating the purpose of the visit. Administrator Rozina Amlani was notified of the visit via telephone and provided with the allegations under review before coming to the facility to assist.

During the visit, LPA conducted staff and resident interviews, toured the physical plant and reviewed resident and hospice records present at the facility. Additional documentation was presented by facility staff in the form of photographs, texts and emails. Witness interviews were also conducted via telephone.

CONTINUED ON FORM LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
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 2
Control Number 22-AS-20260114162139
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: GRAND VIEW VILLA
FACILITY NUMBER: 306005231
VISIT DATE: 01/16/2026
NARRATIVE
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CONTINUED FROM LIC9099
Regarding the allegation that Staff did not seek timely medical attention for resident, the following has been concluded: Based on the evidence gathered, resident R1 was admitted at the facility on May 23, 2024 and has been receiving hospice care since being initially certified on September 23, 2024. On January 11, 2026, R1 had an episode of vomiting followed with lethargia being observed by facility staff on January 12, 2026. Facility staff notified hospice staff and a hospice nurse visit was triggered the same evening as confirmed by hospice records reviewed. A prescription for antibiotics was provided at that time and medication was delivered overnight and provided for self-administration right away on January 13, 2026. Orders for the prescription were reviewed and medication was verified to be present in the medication central storage. At the time of the present visit and per multiple statements gathered, R1 appears more responsive and is observed awake in the facility's common living area.

Regarding the allegation that Staff did not ensure resident was adequately fed and hydrated, the following has been concluded: Per the latest certification and hospice assessment for R1, the resident is placed under aspiration precautions. As a result, upon being found to be lethargic, facility staff were informed to hold on liquids and pureed meals until the resident was awake. Following the initiation of antibiotics treatment, R1 became more responsive and received adequate meals as extensively documented in videos and photographs provided by facility staff. LPA additionally observed R1 being actively fed lunch during the present visit.

Based on the evidence and statement gathered, R1 received adequate medical attention as well as nutrition and hydration. The two allegations are therefore found to be Unfounded, meaning that the allegations are false, could not have happened and/or are without reasonable basis.

An exit interview was conducted and a copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
LIC9099 (FAS) - (06/04)
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