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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005647
Report Date: 02/24/2026
Date Signed: 02/24/2026 02:55:57 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
02/23/2026 and conducted by Evaluator Joseph Alejandre
COMPLAINT CONTROL NUMBER: 22-AS-20260223142018
FACILITY NAME:PACIFIC SUN SENIOR CAREFACILITY NUMBER:
306005647
ADMINISTRATOR:DADABHOY, MUQEETFACILITY TYPE:
740
ADDRESS:24532 SPARTAN STREETTELEPHONE:
(949) 600-5346
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 3DATE:
02/24/2026
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Marla Punzalan, Arnel MojicaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Due to lack of care and supervision Resident eloped out of facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Office Administrator Marla Punzalan and explained the reason for the visit. The investigation into the allegation revealed the following. It was reported that on February 23, 2026, Resident 1 (R1) eloped from the facility around 4:30 am. LPA interviewed R1, R1 did not remember the incident and did not know the date, time or where they were. LPA interviewed Staff 1 (S1). S1 reported that around 4:30 am they heard the doorbell and a person (Witness 1, W1) was with R1 and reported they needed to go back inside. W1 reported they were walking their dog in the morning and came across R1 standing in front the facility on the steps next to the garage leading to the sidewalk. W1 reported that R1 looked distressed and appeared lost so they took them to the front door of the facility and staff let them in. S1 reported that they assessed R1 and there were no apparent injuries and R1 denied any pain. S1 reported they put R1 to bed and they went to sleep. S1 reported that she did not know R1 had left the facility. Staff 2 (S2) reported they were asleep during the incident until R1 was returned to the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
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 3
Control Number 22-AS-20260223142018
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: PACIFIC SUN SENIOR CARE
FACILITY NUMBER: 306005647
VISIT DATE: 02/24/2026
NARRATIVE
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A review of records shows R1 has early signs of Dementia and possible Lewey Body Dementia. R1's responsible party signed their admission agreement. S1 and the Office Administrator reported R1's responsible party was notified about the incident. The Office Administrator reported they have an extra staff member to help prevent future elopements. The preponderance of evidence standard has been met therefore the allegation is substantiated. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260223142018
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: PACIFIC SUN SENIOR CARE
FACILITY NUMBER: 306005647
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/25/2026
Section Cited
CCR
87464(f)(1)
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87464(f)(1)Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not being met as evidenced by...
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Licensee agrees to train staff on CCR 87464 and to provide additional safety precautions such as a mattress pad alarm and door alarm on R1's door to minimize the risk of elopement for R1. Proof of correction to submitted to LPA by the POC due date.
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R1 left the facility on February 23, 2026 around 4:30 am, was outside the facility and was brought back by Witness 1. This
posed an immediate health and safety risk to R1.
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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: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3