306005572-10-23-2025-22-AS-APAO-DMWPZP-20251029114552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005572
Report Date: 10/23/2025
Date Signed: 10/23/2025 12:04:30 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
08/02/2023 and conducted by Evaluator Celine Rodriguez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230802161055

FACILITY NAME:	OLIVE TREE HOME CARE		FACILITY NUMBER:	306005572
ADMINISTRATOR:	DIAZ, FRANCISCA		FACILITY TYPE:	740
ADDRESS:	638 N JAMES PL		TELEPHONE:	(714) 726-3724
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	6	CENSUS: 3	DATE:	10/23/2025
		UNANNOUNCED	TIME BEGAN:	07:00 AM
MET WITH:	Facility Administrator - Francisca Diaz		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Staff did not provide resident with a copy of an admissions agreement.
Staff intimidates resident.
Staff are not meeting resident's bathing needs.
Staff is not providing resident with comfortable accommodations.
Staff isolates resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced continuation visit to the facility and to deliver the findings. LPA Rodriguez explained the purpose of today's visit, was greeted, and granted entry by staff on duty. For this visit, LPA met with facility administrator (AD) Francisca Diaz.

It was alleged that staff did not provide resident with a copy of an admissions agreement. 2 out of 2 resident interviews did not corroborate with the allegation, of which 1 of the residents provided verification that upon admission, resident was provided a copy of the signed admission agreement. 1 out of 1 staff interview did not corroborate with the allegation by disclosing that every resident obtains a copy of their signed admission agreement. Per record review, LPA observed that all current residents have a signed admission agreement.

It was alleged that staff intimidates residents. 2 out of 2 resident interviews did not corroborate with the allegation, by describing staff as “nice” “kind” and denied of experiencing and observing staff intimidate resident or other residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

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-20230802161055

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: OLIVE TREE HOME CARE	FACILITY NUMBER: 306005572
	VISIT DATE: 10/23/2025

NARRATIVE

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1 out of 1 staff interview did not corroborate with the allegation by stating that staff are trained on how to care for and interact with residents. Per record review, LPA observed that current staff complete trainings on residents rights, care and supervision, and mandated reporting.

It was alleged that staff are not meeting resident's bathing needs. 2 out of 2 resident interviews did not corroborate with the allegation, of which 1 resident by provided confirmation that staff will bath resident twice a week, but more if needed. 1 out of 1 staff interview also provided confirmation that residents get bathed twice a week, but in addition, staff will provide towel baths for residents on a daily basis. During the tour of the facility, LPA observed that all residents were clean and that facility is equipped with an adequate supply of toiletries used for bathing.

It was alleged that staff is not providing resident with comfortable accommodations. 2 out of 2 resident interviews did not corroborate with the allegation by expressing their satisfaction with the staff and the living accommodations at the facility. LPA observed that each resident and bedrooms were provided with furniture in good repair, clean linens and adequate storage space. LPA also observed that the temperature in the facility was 75 degrees Fahrenheit, of which all residents provided confirmation that the temperature in the facility was comfortable.

It was alleged that staff isolates resident. 2 out of 2 resident interviews did not corroborate with the allegation, by stating that staff encourage all residents to socialize and partake in activities on a daily basis. 1 out of 1 staff interview stated that staff encourage residents to interact with staff and the other residents to promote engagement and socialization. During the tour of the facility, LPA observed 1 resident engaging with staff in their preferred activity while 1 resident was asleep in their room, and 1 resident who stated they wanted to stay in their room due to personal preference.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegations listed are deemed UNSUBSTANTIATED.

An exit interview was conducted with AD Diaz. A copy of this report was explained, and provided.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025

LIC9099 (FAS) - (06/04)

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