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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006204
Report Date: 06/19/2025
Date Signed: 06/19/2025 02:16:47 PM

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
05/20/2025 and conducted by Evaluator William Vanegas
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250520155200
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: 72DATE:
06/19/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Alma Espinal Administrator TIME COMPLETED:
02:20 PM
ALLEGATION(S):
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-Facility staff are not ensuring that an appropriately skilled professional is assisting the resident with injections
INVESTIGATION FINDINGS:
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On this day Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the allegation listed above. LPA Vanegas was greeted and granted entry to the facility by Administrator (AD) Alma Espinal LPA introduced themselves and stated the purpose of the visit. An initial investigation visit was conducted on May 28, 2025. During the visit, LPA Vanegas gathered and reviewed pertinent records pertaining to residents in care in regard to the allegations stated above. LPA Vanegas interviewed residents. LPA Vanegas also gathered and reviewed employee files relevant to the allegations being investigated. The investigation into the allegation, facility staff are not ensuring that an appropriately skilled professional is assisting the resident with injections, revealed the following. It was alleged that facility staff are injecting residents with insulin. No dates or times were provided of when the alleged violation took place. Staff that were interviewed denied that allegation. The Administrator reported that they have never witnessed facility staff injecting residents in care, and that they have registered nurses on call, but they do not inject residents.
CONITNUED ON LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
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 3
Control Number 22-AS-20250520155200
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: 06/19/2025
NARRATIVE
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Resident 4 (R4) reported that they inject themselves with their own insulin, but a few years ago staff would inject them, but they have not done so in the past two years. Resident 3(R3) reported that they inject themselves with their own insulin, but in the past staff has injected them, no time or dates were provided in regard to the last time staff injected them.

Resident 2 (R2) reported that they inject themselves with their insulin, and they have never witnessed any staff injecting residents in care with insulin. Resident 1 (R1) reported that staff does not inject them with insulin, and if anyone helps them it is their daughter who comes to visit them.

Based on the evidence gathered the preponderance standard has been met therefore the allegation stating, Facility staff are not ensuring that an appropriately skilled professional is assisting the resident with injections, is deemed substantiated. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250520155200
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: 06/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/03/2025
Section Cited
CCR
87629(b)(1)
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87629(b)(1) (b)In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensees who admit or retain residents who require injections shall be responsible for the following:
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Administrator advised that they will ensure that an appropriatley skilled nurce will be in the facility seven days a week to administor injections to residents in care.
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(1)Ensuring that injections are administered by an appropriately skilled professional should the resident require assistance.
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Administrator wil send proof of correction to LPA via email on or before P.O.C due date.
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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: Armando J Lucero
LICENSING EVALUATOR NAME: William Vanegas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3