306005599-2-28-2026-22-AS-APAO-DRW6FW-20260305194702

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005599
Report Date: 02/21/2026
Date Signed: 02/28/2026 09:23:41 AM

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
07/28/2023 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20230728162610

FACILITY NAME:	A1 ELDER CARE		FACILITY NUMBER:	306005599
ADMINISTRATOR:	SHAH, BINDI		FACILITY TYPE:	740
ADDRESS:	2538 E LARKSTONE DRIVE #A		TELEPHONE:	(949) 929-5318
CITY:	ORANGE	STATE: CA	ZIP CODE:	92869
CAPACITY:	6	CENSUS: 6	DATE:	02/21/2026
		UNANNOUNCED	TIME BEGAN:	08:17 AM
MET WITH:	Jay Shah, Licensee		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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-Staff did not provide resident with sufficient room to comfortably and safely accommodate resident.
-Resident bedroom is being used as a passageway to another room, bath or toilet.
-Facility staff did not obtain a building permit prior to facility construction/alterations

INVESTIGATION FINDINGS:

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{***THIS IS AN AMENDED REPORT***}
Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced complaint visit to deliver findings regarding the above-referenced allegations. Upon arrival, LPA Haddadin was greeted and granted entry by the Licensee, Jay Shah, and the purpose of the visit was explained. During the investigation, LPA Haddadin toured the facility, conducted interviews with residents and staff, and reviewed facility records pertinent to the allegations.
It was alleged that facility staff did not obtain a building permit prior to facility construction and/or alterations, that a resident bedroom was being used as a passageway to another room, bathroom, or toilet, and staff did not provide resident with sufficient room to comfortably and safely accommodate resident. LPA reviewed facility records, including the fire clearance documentation, and confirmed the facility had the appropriate fire clearance obtained through the Orange County Fire Department.
{***CONTINUE 9099C***}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2026

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-20230728162610

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: A1 ELDER CARE	FACILITY NUMBER: 306005599
	VISIT DATE: 02/21/2026

NARRATIVE

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{***THIS IS AN AMENDED REPORT***}
LPA conducted interviews with four residents and four staff members, and all interviewees denied the allegations. LPA was unable to interview all residents in care because two of the six residents were unable to verbally communicate due to medical conditions, and reliable statements could not be obtained.
Additionally, LPA toured the facility during the visit and did not observe conditions consistent with the allegations, including any resident bedroom being used as a passageway to another required area. LPA’s observations regarding the allegation that staff did not provide the resident with sufficient room to comfortably and safely accommodate the resident were consistent with the observations noted above and did not corroborate the allegation; additionally, four out of four staff and resident interviews denied this allegation. Record review further reflected that the Department conducted an annual inspection on May 14, 2025, which included a comprehensive inspection of the physical plant, and the inspection documentation did not note concerns or cite deficiencies related to fire clearance, building permits, or unsafe conditions in the facility. LPA’s observations during the current visit were consistent with the information documented during the prior inspection, and no corroborating evidence was identified during interviews or record review.
Based on interviews, observations, and record review, the allegations that facility staff did not obtain a building permit prior to facility construction and/or alterations, that a resident bedroom was being used as a passageway to another room, bathroom, or toilet, and that staff did not provide resident with sufficient room to comfortably and safely accommodate resident were determined to be unsubstantiated. Although the allegations could have occurred, there was insufficient evidence to establish, by a preponderance of the evidence, that a violation occurred.

An exit interview was conducted, and a copy of this report was provided to Licensee, Jay Shah.
{***THIS IS AN AMENDED REPORT***}

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2026

LIC9099 (FAS) - (06/04)

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