306005756-1-23-2026-22-AS-APAO-DR27ZY-20260205210703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005756
Report Date: 01/23/2026
Date Signed: 01/23/2026 10:27:43 AM

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
12/23/2025 and conducted by Evaluator Claudia Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20251223121237

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: 5	DATE:	01/23/2026
		UNANNOUNCED	TIME BEGAN:	08:31 AM
MET WITH:	Van Pao		TIME COMPLETED:	10:40 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff physically abused resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez for the purpose of delivering findings. LPA met with Administrator (AD) Van Pao and explained the purpose of the inspection.

It is alleged Staff 1 (S1) and Staff 2 (S2) physically abused Resident 1 (R1).

Interviews were conducted with five facility residents, including R1, and S1 and S2. During their interview, R1 stated only S1, and not S2 had been physically abusive towards them, however, stated the abuse had occurred in the past. On February 22, 2023, the Department received complaint #22-AS-20230222151633 alleging facility staff sexually abused R1 and on May 16, 2025, the complaint was determined to be unsubstantiated. During their interview, Resident 2 (R2) denied staff being physically abusive to either them or R1 and stated, staff loves R1 and "they love me too!" (Cont. LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

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 2

Control Number 22-AS-20251223121237

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: 01/23/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

During their interview, Resident 3 (R3) was unable to confirm or deny allegation. During their interview, Resident 4 (R4) denied the allegation and stated R1 has a "filthy mouth" and often uses profanity, especially towards staff. R4 denied staff being retaliatory toward R1 either verbally or physically. During their interview, Resident 5 (R5) denied the allegation and stated it is R1 who is physically and verbally abusive towards staff and has attempted to hit staff with their wheelchair on multiple occasions. During their interview, S1 stated R1 often makes comments sexual in nature towards them, however, denied being personally abusive towards R1 and denied having any knowledge of any staff being physically abusive towards R1. During their interview, S2 stated R1 tends to be verbally abusive towards staff, however, denied being personally abusive towards R1 and denied having any knowledge of any staff being physically abusive towards R1, including S1.

Due to allegation being uncorroborated during interviews conducted, the Department is unable to determine if Staff physically abused resident. Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is 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: 01/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2