306005762-9-19-2025-22-AS-APAO-DLYSKK-20250929135653

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005762
Report Date: 09/19/2025
Date Signed: 09/19/2025 01:34:51 PM

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
02/24/2022 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220224074357

FACILITY NAME:	RELIANCE SENIOR HOME		FACILITY NUMBER:	306005762
ADMINISTRATOR:	SANSANO, MINERVA		FACILITY TYPE:	740
ADDRESS:	24672 ELOISA DR		TELEPHONE:	(949) 295-6854
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 6	DATE:	09/19/2025
		UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Lydia Geroy-Caregiver, Administrator-Ray Santianez		TIME COMPLETED:	01:49 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Illegal eviction.
Facility did not provide adequate care and supervision to meet the needs of resident in care.
Facility is not following doctor's order on medication.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegations received on February 24, 2022. LPA was greeted and granted entry into the facility and met with Caregiver Lydia Geroy. LPA explained the reason for the visit. Administrator (AD) Ray Santianez arrived shortly after.

This Department has investigated the complaint alleging that facility issued an illegal eviction. Regarding the allegation the following was revealed: During the course of the interviews one of seven individuals interviewed confirmed the allegation. During the course of the investigation LPA reviewed the Orange County Regional Office Eviction Log and LPA did not observe that an Eviction notice for Resident 1 (R1) was received. During the course of the interviews with residents, R2 reported that she has not received an illegal eviction. During the interviews AD stated that R1 did not received an illegal eviction.

CONTINUED ON LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025

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-20220224074357

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: RELIANCE SENIOR HOME	FACILITY NUMBER: 306005762
	VISIT DATE: 09/19/2025

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

Regarding the allegation that facility did not provide adequate care and supervision to meet the needs of resident in care, the following was revealed: During the course of the interviews one of seven individuals interviewed confirmed the allegation. During the course of the interviews with residents, R2 reported that they have very good staff. Per R2, staff do their best to provide adequate care and supervision for the residents and reported that staff are always working on something. During the course of the interviews, AD reported that staff were doing their best to care for and supervise R1.

Regarding the allegation that facility is not following doctor's order on medication, the following was revealed: During the course of the investigation LPA reviewed documents including the Physician Report (LIC602) dated February 22, 2022, for R1. Per Physician Report R1 is not able to administer own prescription medications. LPA reviewed documents including the Reliance Senior Home Admission Agreement dated February 2, 2022. Per Admission Agreement R1 was admitted to the facility on February 2, 2022. LPA also reviewed the Medication Administration Record (MAR) dated February 2022 for R1. Per MAR, R1 was being giving his medications as prescribed.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.
LPA conducted an exit interview with facility representative, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2