306005927-4-22-2025-22-AS-SSAS-DG2UV5-20250424155430

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005927
Report Date: 04/22/2025
Date Signed: 04/22/2025 12:07:39 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
04/14/2025 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250414153002

FACILITY NAME:	ELEONOR'S PLACE 4		FACILITY NUMBER:	306005927
ADMINISTRATOR:	AVENDANO, DARYLL		FACILITY TYPE:	740
ADDRESS:	24431 ZANDRA DRIVE		TELEPHONE:	(949) 547-5377
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 6	DATE:	04/22/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Mark Ryan Cruz, Administrator		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not ensure that resident was transported to medical appointments.

INVESTIGATION FINDINGS:

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

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the allegation listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Mark Ryan Cruz was notified of the visit via telephone and arrived later to assist.

During the present visit, LPA accompanied by staff conducted a tour of the facility's physical plant. Records for all six currently admitted residents were requested and obtained. One staff interview, three resident interviews and an additional witness interview were conducted during the visit.

Regarding the allegation that Staff did not ensure that resident was transported to medical appointments, the following has been concluded: Based on records reviewed and interviews conducted, a majority of statements made denied any issues in meeting resident health needs due to a lack of available transportation.
CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025

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-20250414153002

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: ELEONOR'S PLACE 4	FACILITY NUMBER: 306005927
	VISIT DATE: 04/22/2025

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

CONTINUED FROM FORM LIC9099
Multiple residents interviewed indicated that their preferred mode of transportation to scheduled medical and dental appointments was provided by their family or responsible parties, but also stated that alternative modes of transportation such as paramedics and non-emergency ambulance were also utilized to meet health needs. One resident stated that they had been experiencing difficulty getting on demand transportation through means provided by the local transportation authority, but the evidence gathered could not confirm whether these issues had an impact on getting their health needs met. The facility's admission agreement was reviewed and found to include "Arrangements to meet health needs, including arranging transportation, as specified in Section 87465, Incidental Medical and Dental Care Services" as part of the basic services being provided. A Technical Assistance Advisory Note reminding licensee of the requirements in the California Code of Regulations was provided during the visit.

Based on the evidence gathered, the allegation listed above is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2