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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005361
Report Date: 08/21/2025
Date Signed: 08/21/2025 01:38:50 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
08/18/2025 and conducted by Evaluator Michael Tea
COMPLAINT CONTROL NUMBER: 22-AS-20250818150104
FACILITY NAME:SPRINGWELL HAVEN, LLCFACILITY NUMBER:
306005361
ADMINISTRATOR:RAMIL DE LOS SANTOSFACILITY TYPE:
740
ADDRESS:2424 FRANCISCO DRIVETELEPHONE:
(949) 524-3484
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY:6CENSUS: 4DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Ramil Delos Santos and Cristina ValerioTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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- Licensee did not ensure resident's electric bed was safeguarded
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conduct a complaint investigation. LPA Tea was greeted and granted entry by facility staff and explained the reason for the visit. Licensee (LE), Ramil Delos Santos and Administrator (AD) Cristina Valerio arrived shortly to assist with the visit.

The department received a complaint on August 18, 2025 and LPA Tea conducted the initial 10-day visit a few days later on August 21, 2025. It was alleged that the licensee did not ensure resident’s electric bed was safeguarded. LPA Tea toured the facility and interviewed facility staff and collected pertinent documents such as staff and resident rosters, copies of Resident 1 (R1)’s file. The investigation determined the following:

A former resident, Resident 1 (R1) moved to another facility. R1 stated the electronic hospital bed is not

(Report continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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 3
Control Number 22-AS-20250818150104
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: SPRINGWELL HAVEN, LLC
FACILITY NUMBER: 306005361
VISIT DATE: 08/21/2025
NARRATIVE
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the original one they had at the former facility. R1 moved on August 6, 2025. It took two trips to move the resident. The first trip had R1 in a gurney. The second trip was their bed, Hoyer lift, wheelchairs and personal belongings. R1 assumed the bed was swapped during moving day. Per review of resident records, every resident at the facility has their own hospital bed that has been ordered from their physician. LPA verified all residents had doctor’s orders for the beds. R1 received a serial number from the medical equipment company SG Home Care for the bed – Code #15033-833-383-180328. LPA verified all the beds at the facility, and it does not match R1’s serial number. LPA toured the entire facility and checked the garage and storage shed and discovered there are no extra hospital beds, all hospital beds in the facility have a resident that occupies it, a total of four beds for the four residents currently at the facility. The extra empty beds in the facility are regular beds, not hospital beds that are used for display for vacant beds. They currently have two vacancies here. Five out of five staff interviewed similarly stated that residents have been staying in their own hospital beds and have never changed beds at all. It is difficult and heavy to disassemble the beds, let alone in a short time span when a resident was transported not far from the facility. One care staff interviewed stated that families of new residents can use the regular beds or they can order a special hospital bed. The facility does not provide hospital beds for the residents.

LPA spoke to care staff regarding safeguarding residents’ personal belongings and property. All the staff similarly answered that there have never been any issues with theft or missing items. They do their best to ensure that residents’ personal belongings are safeguarded. LPA reviewed resident records and noticed the Client/Resident Personal Property and Valuables forms were blank for residents and did not list any items. LPA interviewed Licensee Ramil Delos Santos, and he explained for every resident that moves in, he tells the family to not bring anything of value to the facility. LE Delos Santos tells them not to bring jewelry or expensive stuff to avoid any issues with expensive personal property or items.

LPA spoke to the transportation coordinator from AMA Transport who transported R1 and their personal property and belongings on August 6, 2025. The coordinator stated that 100 percent that is the same bed the resident had. It was never touched, moved or swapped. They had to make two trips because the transport van was not big enough for everything, and they did not want R1 waiting in the gurney for a long time. They tried to move R1’s stuff as quickly as possible. The coordinator said the distance from the facility to R1’s new facility is not far. Once they dropped off R1 at the new facility, they came back to pick up the rest of the items. It was not easy, the coordinator said they had to dissemble the bed. One of the caregivers
(Report continued on LIC9099-C)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250818150104
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: SPRINGWELL HAVEN, LLC
FACILITY NUMBER: 306005361
VISIT DATE: 08/21/2025
NARRATIVE
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helped the movers dissembled it. R1 shares the room so there is not ample room to disassemble a heavy hospital bed and swap it within an hour with a different bed due to the lack of time and space. Three caregivers interviewed witnessed a caregiver staff from the facility help the transport movers disassembled R1’s original bed. All care staff interviewed that were there on moving day confirmed that R1’s original bed was disassembled and transported with all of R1’s belongings that day. Nothing was left on moving day. The facility has in writing and a record that R1 signed a statement stating they received all their items during the move, dated and signed on August 6, 2025.

Therefore, based on LPA Tea's observations and interviews conducted and records reviewed the allegation that the licensee did not ensure residents electric bed was safeguarded has been determined to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiencies cited at this time and an exit interview was conducted with the facility and a copy of the report and confidential names list was provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3