306005756-11-13-2025-22-AS-APAO-DNL2KL-20251119162805

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005756
Report Date: 11/13/2025
Date Signed: 11/13/2025 12:51:02 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/05/2025 and conducted by Evaluator Claudia Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20251105113209

FACILITY NAME:	CARVER SENIOR HOMES 1		FACILITY NUMBER:	306005756
ADMINISTRATOR:	ISAIAH TASHIRO		FACILITY TYPE:	740
ADDRESS:	16202 CAIRO CIRCLE		TELEPHONE:	(714) 572-8821
CITY:	PLACENTIA	STATE: CA	ZIP CODE:	92870
CAPACITY:	6	CENSUS: 6	DATE:	11/13/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Carmen Nicolas		TIME COMPLETED:	01:05 PM

ALLEGATION(S):

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Staff are not meeting resident's dietary needs.
Staff are not providing adequate food service to resident in care.
Staff physically abused residents in care.
Staff verbally abuse residents in care.

INVESTIGATION FINDINGS:

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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez. LPA met with Licensee Carmen Nicolas and explained the purpose of the inspection.

Regarding the allegations, Staff are not meeting resident's dietary needs and Staff are not providing adequate food service to resident in care, the following was revealed: It is alleged Staff 1 (S1) is controlling Resident 1’s (R1’s) food intake at R1’s responsible party, Witness 1’s (W1’s) request. During the course of the investigation, interviews were conducted with R1, S1, W1, four additional facility residents, and two additional staff. During their interview, R1 stated their dietary needs are not being met, as they are hungry all the time. Per R1, they are not served with sufficient food at mealtimes and cannot snack in between meals because W1 is "cuckoo" and tells the staff not to give them any food. During their interview, W1 stated that due to R1’s medical diagnosis, R1 is unable to recall when they last ate, even if they have just eaten, therefore, R1 is often heard saying they are hungry. (Cont. LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025

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-20251105113209

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CARVER SENIOR HOMES 1	FACILITY NUMBER: 306005756
	VISIT DATE: 11/13/2025

NARRATIVE

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Per W1, R1 receives more than enough food and has actually gained weight. W1 stated they would like R1’s diet to be more restricted so R1 may lose weight and maintain their mobility. During their interview, S1 stated R1’s diet consists of a lot of veggies and protein, per W1’s request, however, R1 is served with three meals a day plus snacks. S1 denied R1’s food intake being restricted and stated R1 can have a snack or additional food servings upon request. One of four residents interviewed was unable to confirm or deny the allegations, due their medical diagnosis. Three of four additional residents interviewed stated their dietary needs are being met and they receive sufficient food in quantity. Two of two additional staff interviewed stated residents’ dietary needs are being met and they are provided sufficient food in quantity.

Regarding the allegation, Staff physically abused residents in care, the following was revealed: It is alleged S1 slapped R1 due to R1’s constant cursing. During their interview, R1 denied ever being physically abused by facility staff, including S1. R1 also denied S1 ever slapped them. During their interview, S1 denied personally slapping R1 or any other resident and denied having any knowledge of any facility staff physically abusing any resident. One of four residents interviewed was unable to confirm or deny the allegation, due their medical diagnosis. Three of four additional residents interviewed denied having any knowledge of S1 slapping R1 and denied personally having been physically abused by S1 or any other staff. Two of two additional staff interviewed denied having any knowledge of S1 slapping R1 and denied personally abusing any resident or having any knowledge of any other facility staff physically abusing residents.

Regarding the allegation, Staff verbally abuse residents in care, the following was revealed: It is alleged S2 cursed at R2. During their interview, R2 denied having been verbally abused by facility staff, including S2. During their interview, S2 denied ever cursing at R2 or any other resident. S2 also denied having any knowledge of any facility staff verbally abusing any resident. One of four residents interviewed was unable to confirm or deny the allegation, due their medical diagnosis. Two of four additional residents interviewed stated R1 and R2 are constantly cursing at facility staff, however, denied staff cursing back. During their interview, R1 denied being verbally abused by staff and denied having any knowledge of staff verbally abusing any resident, including R2. Two of two additional staff interviewed denied having any knowledge of S2 cursing at R2 and denied having any knowledge of any other facility staff verbally abusing residents. (Cont. LIC9099-C)

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20251105113209

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CARVER SENIOR HOMES 1	FACILITY NUMBER: 306005756
	VISIT DATE: 11/13/2025

NARRATIVE

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Due to allegations being uncorroborated during interviews conducted, the Department is unable to determine if Staff are not meeting resident's dietary needs, if Staff are not providing adequate food service to resident in care, or if Staff physically or verbally abused residents in care. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore at this time the above allegations are unsubstantiated.

An exit interview was conducted and copy of this report was provided at the end of the inspection.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025

LIC9099 (FAS) - (06/04)

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