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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006096
Report Date: 10/17/2025
Date Signed: 10/17/2025 02:38:21 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
10/10/2025 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251010083616
FACILITY NAME:LOLA SENIOR GUEST HOMEFACILITY NUMBER:
306006096
ADMINISTRATOR:DINH, KEVIN DINOFACILITY TYPE:
740
ADDRESS:8681 LOLA AVENUETELEPHONE:
(714) 699-1614
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:6CENSUS: 5DATE:
10/17/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Kevin Dinh TIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Staff are not properly caring for resident's pressure injury resulting in it getting worse
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the complaint investigation into the allegation above. LPA Haley was greeted, granted entry and explained the reason for the visit to staff. Staff contacted Administrator (AD) Kevin Dinh who arrived and was present the remainder of the visit. During the investigation, interviews were conducted with staff, medical professionals and a resident.

Regarding the allegation above, 3 of 4 individuals, including medical professionals provided information that contradict the complaint allegation. During the investigation it was discovered, Resident 1 (R1) has a pressure wound on the left buttock. R1 is currently under the care of their hospice provider and receives hygiene services from the hospice provider three times a week: Monday's, Wednesday's, and Friday's. Since the pressure ulcer re-opened, wound care services are now being provided twice a week by hospice.
W1 confirmed the presence of a pressure sore on R1’s buttocks. W1 stated the wound was a stage 2 wound, and as of October 10, 2025, the wound was healing well.
Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
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-20251010083616
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: LOLA SENIOR GUEST HOME
FACILITY NUMBER: 306006096
VISIT DATE: 10/17/2025
NARRATIVE
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A review of the hospice documents reveals the redness on the left buttock opened, and classified as a stage 2 pressure ulcer. Hospice document review and interview confirmation reveal, facility staff were instructed on how to provided care for the resident’s pressure sore and reposition the resident to keep pressure off their butt.

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 violations occurred; therefore, the allegation is deemed Unsubstantiated.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2