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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005287
Report Date: 05/07/2025
Date Signed: 05/07/2025 02:06:27 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
05/02/2025 and conducted by Evaluator Hanna Gough
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250502145409
FACILITY NAME:AMERIHEART CARE HOMEFACILITY NUMBER:
306005287
ADMINISTRATOR:YCASAS, TIMOTHYFACILITY TYPE:
740
ADDRESS:9622 KATELLA AVENUETELEPHONE:
(714) 733-8095
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 5DATE:
05/07/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Roy Santa Ana TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff do not treat residents with dignity and respect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Hanna Gough and Ruth Martinez made an unannounced visit for the purpose of investigating the above mentioned complaint allegation. LPAs met with Administrator (AD) Roy Santa Ana and discussed the purpose of the inspection.

The investigation in the allegation that facility staff do not treat residents with dignity and respect revealed the following: During the course of the inspection, LPAs toured the facility, conducted interviews with staff and residents and obtained copies of the staff roster, resident roster, and resident file. Interviews with 3 of 3 staff revealed that Staff #1 (S1) was assisting Resident #1 (R1) in the restroom and when S1 was finished cleaning, they went to the kitchen and was talking with Staff #2 (S2) in another language amongst themseIves. R1 overheard them laughing from their bedroom and thought that the staff were

Continue on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
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-20250502145409
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: AMERIHEART CARE HOME
FACILITY NUMBER: 306005287
VISIT DATE: 05/07/2025
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
laughing at them. Interview with 1 of 1 resident revealed that S1 assisted R1 with incontinence care and once finished S1 went to another part of the facility and was speaking with S2 when R1 heard staff speaking to each other and laughing. R1 assumed staff were laughing at them, but R1 realized it was a misunderstanding and staff were not laughing at R1.

Based on information gathered during the investigation the department is unable to ascertain if the above 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, this allegations is deemed UNSUBSTANTIATED.

An exit interview was conducted with Administrator Roy Santa Ana and a copy of this report was provided at the time of the investigation.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2