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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006057
Report Date: 10/28/2025
Date Signed: 10/28/2025 06:57:44 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
10/20/2025 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251020134502
FACILITY NAME:SOLIVEN CARE HOMEFACILITY NUMBER:
306006057
ADMINISTRATOR:SOLIVEN, JOSELOLITOFACILITY TYPE:
740
ADDRESS:6710 SEQUOIA DR.TELEPHONE:
(714) 310-9293
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:6CENSUS: 5DATE:
10/28/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Joselolito Soliven TIME COMPLETED:
02:59 PM
ALLEGATION(S):
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Lack of care and supervision led to pressure injury
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit regarding the complaint allegations above. LPA Haley was greeted, granted entry and explained the reason for the visit before entering the facility. During the visit LPA Haley toured the facility, interviewed staff, witnesses, and collected and reviewed relevant documents.

Regarding the allegation: Lack of care and supervision led to pressure injury

0 of 6 individuals interviewed could provide any supporting evidence or information related to the pressure injury sustained while in care. Interviews were conducted with facility staff, medical professionals, and hospital documents were reviewed. 2 facility staff did confirm there was some redness observed on resident 1’s (R1) buttocks; however, both staff denied there was any break of the skin.
R1 was sent to the hospital on October 13, 2025, for swelling to the legs.
Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
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-20251020134502
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: SOLIVEN CARE HOME
FACILITY NUMBER: 306006057
VISIT DATE: 10/28/2025
NARRATIVE
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A review of the hospital discharge summary for R1 did not mention anything about a pressure wound or pressure ulcer. The discharge summary states the resident was diagnosed with DVT of lower extremity, bilateral history of dementia, and leg pain-swelling.

Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed Unsubstantiated.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2