306006006-3-6-2026-22-AS-SSAS-DS4M22-20260312091245

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006006
Report Date: 03/06/2026
Date Signed: 03/06/2026 10:55:47 AM

Substantiated

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
12/02/2024 and conducted by Evaluator Alvaro Ramirez Jr.

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20241202221220

FACILITY NAME:	HEYDAY SENIOR LIVING OF COSTA MESA		FACILITY NUMBER:	306006006
ADMINISTRATOR:	ALIM, REA BADILLO		FACILITY TYPE:	740
ADDRESS:	2750 LORENZO AVE		TELEPHONE:	(562) 303-0130
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	6	CENSUS: 5	DATE:	03/06/2026
		UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	Airhyn Miranda-Caregiver		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff neglect resulted in a resident sustaining multiple pressure injuries

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on an investigation completed by the Department. LPA was greeted and granted entry into the facility by Caregiver Airhyn Miranda. Administrator (AD) Jerome Alim was notified by staff via telephone.

During the course of the investigation, the Department interviewed staff and witnesses as well as reviewed and obtained documentation such as Admission Agreement, Physician Report (LIC602), Identification and Emergency Information, Preplacement Appraisal Information, Unusual Incident/Injury Report (UIIR), Allied Hospice Plan of Care, and Kaiser Permanente and Hoag Memorial Hospital Admission/discharge records. This Department has investigated the complaint alleging that staff neglect resulted in a resident sustaining multiple pressure injuries. Resident 1 (R1) was admitted to the facility on November 07, 2022. R1’s Physician Report (LIC602A) dated July 02, 2024, lists R1 as having a diagnosis of Dementia. Per Physician report R1 is non-verbal, unable to make needs known and requires maximum assistance with all Activities of Daily Living (ADLs). R1 is non-ambulatory and cannot independently transfer to and from bed.
CONTINUED ON LIC9099-C...

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20241202221220

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: HEYDAY SENIOR LIVING OF COSTA MESA	FACILITY NUMBER: 306006006
	VISIT DATE: 03/06/2026

NARRATIVE

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During the investigation LPA reviewed documents including the Allied Hospice Care, Inc. Plan of Care dated July 15, 2024, for R1. Per Plan of Care, R1 was admitted to Hospice on July 2, 2024. Per Plan of Care, on November 4, 2024, Hospice services were discontinued for R1. LPA reviewed the Hoag Memorial Hospital Admission records dated November 28, 2024, for R1. Per Admission records, R1 was admitted to the Hospital on November 28, 2024. Per Admission records, R1 was admitted to the Hospital for multiple pressure injuries present on admission: Coccyx – unstageable; left hip – stage 2; left foot and left ankle – stage 2, all of which required wound care treatment.

LPA reviewed the Program Clinical Consultant’s (PCC) Report dated December 4, 2025, for R1. Per PCC, following R1’s Hospice discontinuation on November 4, 2024, the facility assumed full responsibility for the R1’s ongoing care without Hospice support. Per PCC, during this post-hospice period, the facility did not implement preventive skin measures, nor conduct routine skin monitoring/assessment. Per PCC, the timeline supports the evidence that pressure injuries developed during a period of insufficient preventive care and delayed medical intervention following Hospice discharge and/or days leading to R1’s hospitalization on November 28, 2024. Despite R1’s non-ambulatory status, full dependence on Activities of Daily Living (ADLs), incontinence care, and poor nutritional intake, there was no documented evidence regarding an updated individualized care plan and/or a routine repositioning protocol.

Based on the evidence gathered, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. The facility is cited per Title 22, Division 6 of the California Code of Regulations.

An exit interview was conducted and a copy of this report, LIC9099-D, and Appeal Rights were provided.
An exit interview was conducted with facility representative, and a copy of this report was left at the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20241202221220

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: HEYDAY SENIOR LIVING OF COSTA MESA	FACILITY NUMBER: 306006006
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/09/2026 Section Cited CCR 87464(f)	1 2 3 4 5 6 7	Basic Services 87464 (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidence by: Per Admission records, R1 was admitted to the Hospital for	1 2 3 4 5 6 7	Facility licensee/administrator to submit a written statement that this regulation was understood. Proof of completion of training about Care and supervision of Administrator and all caregivers. To submit a facility plan procedure how staff will prevent residents from sustaining multiple pressure
	8 9 10 11 12 13 14	multiple pressure injuries present on admission including Coccyx – unstageable. This poses an immediately an immediately health and safety risk to residents in care.	8 9 10 11 12 13 14	injuries while in care. To submit by 3/20/2026.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

LIC9099 (FAS) - (06/04)

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