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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006264
Report Date: 02/20/2026
Date Signed: 02/20/2026 11:57:47 AM

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
02/11/2026 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20260211095337
FACILITY NAME:IRVINE COTTAGE #4FACILITY NUMBER:
306006264
ADMINISTRATOR:ARNETT, KIMBERLYFACILITY TYPE:
740
ADDRESS:7 PRINCETONTELEPHONE:
(949) 533-5938
CITY:IRVINESTATE: CAZIP CODE:
92620
CAPACITY:6CENSUS: 6DATE:
02/20/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Kimberly Arnett - Administrator TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Resident sustained a bruise due to staff neglect or physical abuse
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

The Department received a complaint on 02/11/2026. During the visit LPA Mendivil interviewed staff and residents and obtained copies of staff schedule and resident documents. Regarding the allegation resident sustained a bruise due to staff neglect or physical abuse, the investigation revealed the following:

It was alleged that a resident sustained a bruise due to staff neglect or abuse. Per interview with Administrator Kimberly Arnett, it was reported that Resident 1 (R1) sustained a bruise on ring finger on left hand on 01/26/2026. AD stated Staff 1 (S1) reported the injury to Staff 2 (Staff 2) and S2 came to the facility to assess the bruising.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
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-20260211095337
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 #4
FACILITY NUMBER: 306006264
VISIT DATE: 02/20/2026
NARRATIVE
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AD stated she reported the injury to R1's family and a visit from home health was coordinated for an xray on 01/30/2026. AD stated R1's family reported the results of xray as no fractures to the left hand on 02/04/2026. Per review of R1 is diagnosed with anemia and per interviews with staff R1 can refuse assistance with activities of daily living. Per interviews with 4 out of 4 staff stated they have not been neglectful or abusive to R1 or any residents in care. LPA Mendivil was unable to interview residents as they were not oriented to space and time.

Therefore based on the preponderance of evidence through interviews and records reviewed the allegation Resident sustained a bruise due to staff neglect or physical abuse is 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: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2