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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006260
Report Date: 03/27/2026
Date Signed: 03/27/2026 02:41:08 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/02/2025 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20251202134153
FACILITY NAME:IRVINE COTTAGE #1FACILITY NUMBER:
306006260
ADMINISTRATOR:ARNETT, KIMBERLYFACILITY TYPE:
740
ADDRESS:1 LONGSTREETTELEPHONE:
(949) 533-5938
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY:6CENSUS: 6DATE:
03/27/2026
UNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Michelle Nesbitt - Compliance Manager TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff are not meeting the needs and services of a resident
Staff are not allowing a resident to communicate
Staff do not have planned activities for a resident
Staff are unable to communicate effectively
Staff are not providing water to a resident
Staff are overmedicating a resident
Resident sustained multiple bruises due to staff neglect or physical abuse
Staff do not ensure a resident is being provided appropriate therapy
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facilty and explained the reason for the visit.

The Department received a complaint on 12/02/2025 and the initial complaint visit was conducted on 12/04/2025. LPA Mendivil interviewed staff and residents as well as obtained copies of resident records including physician report, hospital paperwork. Regarding the allegations Staff are not meeting the needs and services of a resident, Staff are not allowing a resident to communicate , Staff do not have planned activities for a resident, Staff are unable to communicate effectively , Staff are not providing water to a resident , Staff are overmedicating a resident, Resident sustained multiple bruises due to staff neglect or physical abuse, Staff do not ensure a resident is being provided appropriate therapy the investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026
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-20251202134153
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: IRVINE COTTAGE #1
FACILITY NUMBER: 306006260
VISIT DATE: 03/27/2026
NARRATIVE
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 Regarding the allegation that staff are not meeting residents’ needs. Per interviews with 7 out of 7 staff stated they are able to meet residents needs. Per Kimberly all residents are assessed prior to moving into the facility to ensure they are appropriately fit. Interviews with 2 out of 5 residents interviewed on 12/04/2025 stated facility offers different activities. 3 of the residents were unavailable to be interviewed or not oriented to space and time.
Regarding the allegation that staff are not allowing residents to communicate, Per interviews with 7 out of 7 staff they are not restricting any residents from communicating with anyone. During interviews staff expressed understanding for resident’s personal rights including residents having communication.
Regarding the allegation staff do not have planned activities. Per interviews with 7 out 7 staff stated they offer different activities including walks out of the facility. Per staff they utilize Youtube for chair workouts. Interviews with 2 out of 5 residents interviewed stated facility offers different activities.
Regarding the allegation staff are unable to communicate effectively. Per interviews with 7 out of 7 staff indicate they are able to communicate effectively with residents and their families. LPA Mendivil was able to individually interview caregiving staff and they were able to communicate with LPA Mendivil.
Regarding the allegation staff are not providing water to a resident Interviews with 7 out of 7 staff stated residents are provided with water and juice throughout the day. LPA Mendivil observed on 12/04/2025 and again on 03/27/2026 all residents have their own cups with water or juice. Interviews with 2 out of 5 residents stated they have water or juice available at all times.
Regarding the allegation Staff are overmedicating a resident. Per interviews with 7 out of 7 staff stated they are not overmedicating residents. Staff stated they give medications are prescribed and would not give more than prescribed. Interviews with 2 out of 5 residents indicated they are not being overmedicated.
Regarding the allegation resident sustained multiple bruises due to staff neglect or physical abuse. Per interviews with 7 out of 7 staff indicate staff are not neglectful or abusive towards residents in care. 2 out of 5 residents denied that staff is abusive or neglectful.
Regarding the allegation staff do not provide the appropriate therapy per interviews with 7 out of 7 staff stated they will follow physician's orders for any therapy needed for the residents.
Therefore based on the preponderance of evidence through records reviewed and interviews the allegations are determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred.
No deficiencies cited.
An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2