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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005597
Report Date: 07/09/2025
Date Signed: 07/09/2025 01:16:37 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
07/06/2023 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 22-AS-20230706120931
FACILITY NAME:COAST SENIOR CARE 3FACILITY NUMBER:
306005597
ADMINISTRATOR:VIANA, KRISTENFACILITY TYPE:
740
ADDRESS:6822 MARILYN DRTELEPHONE:
(714) 470-0194
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 5DATE:
07/09/2025
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Renato GaldonesTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Resident sustained an unexplained fracture while in care.
Resident developed multiple pressure injuries while in care
Staff do not ensure that dietary needs are being met for resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kerry Hiratsuka, conducted this unannounced complaint visit to deliver the results of the allegations above.

The Department conducted an investigation into allegations above. The allegations were made in 2023. Per medical records obtained by the department the fracture in question was sustained a year prior to the resident moving into the facility. Per the medical records obtained by the department the resident did not develop any pressure injuries while in care.

Residents have the personal right to refuse foods that are offered to them that meet dietary needs prescribed by their doctor. From information gathered the resident in question did not complain of the food. LPA was able to interview two of five current residents and also two long time caregivers. The interviews state the staff do their best to cook food that meet resident needs.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
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-20230706120931
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: COAST SENIOR CARE 3
FACILITY NUMBER: 306005597
VISIT DATE: 07/09/2025
NARRATIVE
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Based on information above, the department concluded that the allegations are Unfounded. A finding that an allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

no deficiencies cited
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2