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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006031
Report Date: 05/19/2025
Date Signed: 05/20/2025 11:15:37 AM

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
12/06/2024 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 22-AS-20241206161458
FACILITY NAME:PORT MINOAFACILITY NUMBER:
306006031
ADMINISTRATOR:ROCHE, RYANFACILITY TYPE:
740
ADDRESS:25601 MINOA DRIVETELEPHONE:
(949) 916-9228
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
05/19/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:RYAN ROCHETIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained multiple falls while in care resulting in fractures due to staff neglect.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 05/19/25, Donna Gurriere, Licensing Program Analyst (LPA) contacted the licensee/ administrator via phone to deliver final findings regarding a complaint that was received 12/06/2024. LPA Gurriere spoke with Ryan Roche, Administrator and explained the purpose of the call.

Resident sustained multiple falls while in care resulting in fractures due to staff neglect.

During the interview process, the administrator, four staff persons and the resident (Resident 1) were interviewed. In addition, documents were reviewed and obtained to include the Physicians Report, Appraisal and Needs, Incident Report, Hospital Discharge paperwork, Personnel Report, Resident Roster, and Admission Agreement.

continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
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-20241206161458
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: PORT MINOA
FACILITY NUMBER: 306006031
VISIT DATE: 05/19/2025
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
During the investigation of a complaint received on 12/06/24 it was reported that on 12/05/24 the resident complained of pain in her lower right back by grabbing the area with her hand, moaning and facial grimacing. Two staff persons checked the area and believed that the area was swollen. The resident was transferred to the hospital where she was diagnosed with lower right side (back) rib fractures.

The staff reported that the resident had not been seen by suffering a fall or any other type of accident. Medical records indicated that the resident had suffered numerous fractures throughout her body that were healed, healing or acute. There was adequate staff supervision (two staff) during the time that the resident complained of her pain and staff responded quickly and appropriately reporting the resident’s pain/change in condition and getting her medical aid.

Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above findings are Unsubstantiated.

Licensee or administrator was advised a copy of this report will be sent via certified mail. Two copies of the report will be sent. Licensee or administrator is to sign and return a copy to the Orange County Regional Office.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2