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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005385
Report Date: 01/15/2026
Date Signed: 01/15/2026 02:52:31 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
10/13/2025 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251013161555
FACILITY NAME:ORANGE COUNTY CARE HOME IIFACILITY NUMBER:
306005385
ADMINISTRATOR:RASSOULI ZADEHEI, FAHIMEHFACILITY TYPE:
740
ADDRESS:27561 ALMENDRA DRIVETELEPHONE:
(949) 322-1078
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
01:41 PM
MET WITH:Faith Rasouli, administratorTIME COMPLETED:
02:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not give proper notification of eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst made an unannounced visit to the facility for the purpose of following up on the investigation of the three allegations listed above as well as to deliver findings to the facility. LPA was greeted and granted entry by administrator Faith Rasouli after stating the purpose of the visit. Allegations under review were listed during the visit.

An initial complaint investigation visit was conducted by licensing staff on October 14, 2025. During the visit, LPA Rodriguez toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed. Additional witness interviews conducted during the investigation.

During the present visit, LPA conducted a tour of the physical plant and reviewed resident records for six currently admitted individuals.
CONTINUED ON FORM LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
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 7
Control Number 22-AS-20251013161555
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: ORANGE COUNTY CARE HOME II
FACILITY NUMBER: 306005385
VISIT DATE: 01/15/2026
NARRATIVE
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Facility did not give proper notification of eviction, the following has been concluded: On October 10, 2025, facility administrator Faith Rasouli sent an email to the responsible party and attorney-in-fact for former facility resident R1 with the intention to notify the responsible party that R1's assessed care needs were no longer compatible with the care and supervision levels provided at the facility. However, upon review of the message, it was determined that the notice did not include the following elements as required by Section 87224 of the California Code of Regulation on Eviction Procedures:

- A copy of the resident’s current service plan.
- A list of referral agencies.
- The right of the resident or resident’s legal representative to contact the department to investigate the reasons given for the eviction pursuant to Section 1569.35.
- The contact information for the local long-term care ombudsman, including address and telephone number.

As a result, the allegation is determined to be Substantiated, meaning that the preponderance of evidence standards has been met. A type B deficiency is cited on an attached form LIC9099-D.

Administrator Faith Rasouli had to leave the premises before the conclusion of the visit and authorized caregiving staff Johnny Bugtong to sign the report on her behalf. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
10/13/2025 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251013161555

FACILITY NAME:ORANGE COUNTY CARE HOME IIFACILITY NUMBER:
306005385
ADMINISTRATOR:RASSOULI ZADEHEI, FAHIMEHFACILITY TYPE:
740
ADDRESS:27561 ALMENDRA DRIVETELEPHONE:
(949) 322-1078
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
01:41 PM
MET WITH:Faith Rasouli, administratorTIME COMPLETED:
02:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not notify responsible party regarding resident's health condition
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst made an unannounced visit to the facility for the purpose of following up on the investigation of the three allegations listed above as well as to deliver findings to the facility. LPA was greeted and granted entry by administrator Faith Rasouli after stating the purpose of the visit. Allegations under review were listed during the visit.

An initial complaint investigation visit was conducted by licensing staff on October 14, 2025. During the visit, LPA Rodriguez toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed. Additional witness interviews conducted during the investigation.

During the present visit, LPA conducted a tour of the physical plant and reviewed resident records for six currently admitted individuals.
CONTINUED ON FORM LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 22-AS-20251013161555
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: ORANGE COUNTY CARE HOME II
FACILITY NUMBER: 306005385
VISIT DATE: 01/15/2026
NARRATIVE
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Facility did not notify responsible party regarding resident's health condition, the following has been concluded: Based on staff interviews and a review of text and email communications between staff and R1's responsible party, licensing staff was able to establish a clear pattern of updates and communication regarding R1's health condition and management of the diabetes diagnosis. Administrator was however unable to trace back documentation that a toe infection had effectively been notified ahead of a specialist appointment during which it was additionally evidenced. There is insufficient evidence to corroborate or discard the allegation.

As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred.

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

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 22-AS-20251013161555
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: ORANGE COUNTY CARE HOME II
FACILITY NUMBER: 306005385
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/29/2026
Section Cited
CCR
87224(d)(1)
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Per CCR 87224(d)(1) The notice to quit shall include the following information: (B) Resources available to assist in identifying alternative housing and care options (...). This requirement was not met as evidenced by:
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Licensee reviewed Section 87224 on Eviction Procedures and verbalized understanding the requirements. Deficiency cleared during the visit.
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Based on records reviewed, the notice served to R1's responsible party did not include the necessary elements detailed in Title 22. This constitutes a potential risk to the health, safety and personal rights of individuals in care.
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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: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
10/13/2025 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251013161555

FACILITY NAME:ORANGE COUNTY CARE HOME IIFACILITY NUMBER:
306005385
ADMINISTRATOR:RASSOULI ZADEHEI, FAHIMEHFACILITY TYPE:
740
ADDRESS:27561 ALMENDRA DRIVETELEPHONE:
(949) 322-1078
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
01:41 PM
MET WITH:Faith Rasouli, administratorTIME COMPLETED:
02:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was issued an unlawful eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst made an unannounced visit to the facility for the purpose of following up on the investigation of the three allegations listed above as well as to deliver findings to the facility. LPA was greeted and granted entry by administrator Faith Rasouli after stating the purpose of the visit. Allegations under review were listed during the visit.

An initial complaint investigation visit was conducted by licensing staff on October 14, 2025. During the visit, LPA Rodriguez toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed. Additional witness interviews conducted during the investigation.

During the present visit, LPA conducted a tour of the physical plant and reviewed resident records for six currently admitted individuals.
CONTINUED ON FORM LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 22-AS-20251013161555
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: ORANGE COUNTY CARE HOME II
FACILITY NUMBER: 306005385
VISIT DATE: 01/15/2026
NARRATIVE
1
2
3
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5
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12
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14
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Resident was issued an unlawful eviction, the following has been concluded: Based on interviews with the facility administrator as well as witnesses, it was determined that alternate placement was eventually found in order to better meet resident R1's care needs without resorting to a formal eviction.

As a result, the allegation is determined to be Unfounded, meaning that the allegation is false, could not have happened and/or is 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: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 7