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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006204
Report Date: 05/20/2025
Date Signed: 05/20/2025 11:49:13 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
05/15/2025 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250515094714
FACILITY NAME:WILLOW VIEW GARDENS MEMORY CARE & ASSISTED LIVINGFACILITY NUMBER:
306006204
ADMINISTRATOR:ESPINAL, ALMAFACILITY TYPE:
740
ADDRESS:2025 N BUSH STTELEPHONE:
(714) 541-3357
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:130CENSUS: 73DATE:
05/20/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Christine Juarez- LicenseeTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Resident's personal rights were violated.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of initiating the complaint investigation into the above allegation. LPA was greeted and granted entry by Housekeeper Alice Castillo and stated the purpose of the visit to Activity Director (AD) Maroma Herrera. During the course of the investigation, LPA interviewed three staff, however the resident in question, (R1), had passed away due to natural causes on May 3, 2025, and could not be interviewed. LPA obtained pertinent records such as the resident/staff rosters, March/May 2025 activity calendars, R1's face sheet, physician's report, admission agreement, death certificate, as well as the employee handbook, and resume of Staff #1 (S1).

The investigation revealed the following:
Regarding the allegation, Resident's personal rights were violated, it was reported that a TikTok video of R1 and S1 dancing was posted on S1's TikTok account. Based on the review of S1's Tiktok account, there were no videos of residents posted for the public viewing.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
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 3
Control Number 22-AS-20250515094714
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: WILLOW VIEW GARDENS MEMORY CARE & ASSISTED LIVING
FACILITY NUMBER: 306006204
VISIT DATE: 05/20/2025
NARRATIVE
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S1 indicated that the video in question was not uploaded publicly by demonstrating that TikTok videos could be saved and downloaded with the TikTok watermark without being uploaded. LPA confirmed no evidence of videos were posted publicly. However, LPA viewed a total of six videos set privately which is often indicated by a lock icon under the "lock" tab. Per Google, the lock tab on TikTok refers to the option to make your profile and videos private, meaning only your followers can see them, or you can further restrict visibility to "only me." LPA observed four out of the six privately set Tiktok videos had views ranging from 8-274 views with comments. Based on the review of the Employee Handbook, S1 violated Section Five: Standards of Conduct, which documents that inappropriate behavior such as "interaction with residents that is unprofessional during the course of providing resident care."

It is determined that there were sufficient corroborating evidence based on the interviews and record review, therefore, the allegation of Resident's personal rights were violated, is deemed SUBSTANTIATED. See the attached LIC9099-D.

An exit interview was conducted with Licensee Christine Juarez, and a copy of this report along with the LIC9099-C, LIC9099-D, LIC811, and the appeal rights were provided at the end of the visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250515094714
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: WILLOW VIEW GARDENS MEMORY CARE & ASSISTED LIVING
FACILITY NUMBER: 306006204
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/27/2025
Section Cited
CCR
87468.2(a)(1)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) "To have a reasonable level of personal privacy..." This requirement was not met as evidenced by:
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Licensee and Administrator stated that proof of an in-service training covering the personal rights of residents will be conducted and an addendum will be created regarding a written/opt out consent to take photgraphs and video recordings will be submitted to LPA via email by POC due date.
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Based on interviews and record review, there were four out of six private videos with views from followers ranging from 8-274 which poses a potential Personal Rights risk to persons in care.
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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: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3