<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005991
Report Date: 11/03/2025
Date Signed: 11/03/2025 03:17:49 PM

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
04/13/2023 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230413144738
FACILITY NAME:GARDEN GROVE GUEST HOME LLCFACILITY NUMBER:
306005991
ADMINISTRATOR:TISTOJ, RUTHFACILITY TYPE:
740
ADDRESS:12882 SHACKELFORD LANETELEPHONE:
(714) 638-9470
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:47CENSUS: 38DATE:
11/03/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Britni Paige Rohrer- Assistant Administrator/Wellness DirectorTIME COMPLETED:
03:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure residents thermostat in room was working properly.
Staff did not ensure residents room does not smell like urine.
Staff did not ensure residents bathroom and floors are cleaned timely.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jessica Cho made an unannounced subsequent visit for the purpose of continuing the investigation into the above allegations. LPA met with Assistant Administrator(AA)/Wellness Director (WD) Paige Rohrer and explained the reason for the visit.

On April 13, 2023, the Department received the complaint which the investigation was initiated by LPA Jenifer Tirre on April 20, 2023. During the course of the investigation, LPA Tirre and/or Cho toured the faciltiy, conducted interviews with two staff and four residents, and obtained the following documentation: Resident/Staff Rosters, Housekeeping Schedule, Face Sheets, and Physician's Reports.

The investigation is as follows: Regarding the allegation, Staff did not ensure resident's thermostat in room was working properly, it is alleged that the thermostat in the unit was broken for three months. LPA observed no thermostats in the the four resident units inspected also corroborated by two out of two staff.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2025
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-20230413144738
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: GARDEN GROVE GUEST HOME LLC
FACILITY NUMBER: 306005991
VISIT DATE: 11/03/2025
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
LPA observed one thermostat in each hallway, and a comfortable temperature was maintained throughout the facility and in the four units, 78-80 degrees Fahrenheit.

Regarding the allegation, Staff did not ensure residents' room does not smell like urine, there was no urine odor throughout the facility and shared bathrooms in four out of four units inspected. There was no urine on the floor and no odor in any bathrooms. Four out of four residents and two out of two staff denied the allegation indicating that bathrooms are cleaned daily and as needed.

Regarding the allegation, Staff did not ensure resident bathrooms and floors are cleaned timely, LPA observed one housekeeper cleaning the facility during the visit. LPA observed the floors in the shared bathrooms in four of four units and two shared showers in the hallways were clean and sanitary.

Therefore, this agency has investigated the complaint and based on the observations made, interviews which were conducted, and the records that were reviewed, all allegations are deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Assistant Administrator/Wellness Director Paige Rohrer, and a copy of this report was provided at exit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2