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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005756
Report Date: 01/21/2026
Date Signed: 01/21/2026 11:55:32 AM

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
04/24/2023 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230424101734
FACILITY NAME:CARVER SENIOR HOMES 1FACILITY NUMBER:
306005756
ADMINISTRATOR:DE GUZMAN, VIRGILIOFACILITY TYPE:
740
ADDRESS:16202 CAIRO CIRCLETELEPHONE:
(714) 572-8821
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 5DATE:
01/21/2026
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Administrator Van PaoTIME COMPLETED:
12:10 PM
ALLEGATION(S):
1
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8
9
Facility staff handled resident roughly
INVESTIGATION FINDINGS:
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5
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9
10
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12
13
On January 21, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Van Pao was notified via telephone and later arrived to assist with the inspection.

During the course of the investigation, the Department interviewed residents, interviewed staff, reviewed and obtained pertinent documents for this complaint. Regarding the allegation, facility staff handled resident roughly, the following has been concluded: It was alleged that facility staff handled Resident # 1 (R1) roughly. LPA attempted to speak with R1 regarding this allegation, however, R1 refused to be interviewed. LPA conducted five staff interviews. Five out of the five staff interviewed denied the allegation and stated that staff have never handled R1 in a rough manner. Staff interviewed also stated that R1 has made similar allegations in the past, all of which have been false. LPA conducted four resident interviews.
CONTINUED ON LIC9099-C
Unfounded
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
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 4
Control Number 22-AS-20230424101734
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: CARVER SENIOR HOMES 1
FACILITY NUMBER: 306005756
VISIT DATE: 01/21/2026
NARRATIVE
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Four out of the four residents interviewed denied the allegation and stated that they have never been treated roughly by staff. Residents interviewed also stated that they have never seen staff treat any other resident in a rough manner. Additionally, two out of the four residents interviewed stated that R1 has made similar allegations about the staff in the past, all of which have been false.

Based on the evidence gathered during this investigation, the complaint is UNFOUNDED, meaning that the allegations is false, could not have happened and/or is without reasonable basis. An exit interview was conducted with Administrator Van Pao and a copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
04/24/2023 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230424101734

FACILITY NAME:CARVER SENIOR HOMES 1FACILITY NUMBER:
306005756
ADMINISTRATOR:DE GUZMAN, VIRGILIOFACILITY TYPE:
740
ADDRESS:16202 CAIRO CIRCLETELEPHONE:
(714) 572-8821
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 5DATE:
01/21/2026
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Administator Van PaoTIME COMPLETED:
12:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not adequately address a change in resident's health condition
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On January 21, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator (AD) Van Pao was notified via telephone and later arrived to assist with the inspection.

During the course of the investigation, the Department interviewed residents, interviewed staff, reviewed and obtained pertinent documents for this complaint. Regarding the allegation, staff did not adequately address a change in the resident’s health condition, the following has been concluded: It was alleged that staff did not adequately address a change in Resident #1 (R1) health condition. LPA attempted to speak with R1 regarding this allegation, however, R1 refused to be interviewed. LPA conducted five staff interviews. Five out of the five staff interviewed denied the allegation. Staff interviewed stated that attempts to address the changes in R1's health conditions have been unsuccsessful, due to R1 refusing to partipate in his plan of care. CONTINUED ON LIC9099-C

Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20230424101734
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: CARVER SENIOR HOMES 1
FACILITY NUMBER: 306005756
VISIT DATE: 01/21/2026
NARRATIVE
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5
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12
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Staff interviewed stated that R1 has refused to participate in meetings about his care, R1 has refused to take his medication at times, R1 has refused to be bathed by staff at times, R1 has refused to follow the diet recommended to him by his primary care physician, and R1 has refused for staff to help him with his hygiene needs at times. Staff interviewed stated that R1 has been allowed to refuse care, so that staff do not violate his personal rights.

Based on the evidence gathered during the investigation, the Department 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 allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Van Pao and a copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4