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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006342
Report Date: 03/16/2026
Date Signed: 03/16/2026 05:14:38 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
12/23/2025 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251223153341
FACILITY NAME:MARIGOLD BOARD AND CAREFACILITY NUMBER:
306006342
ADMINISTRATOR:TRANAE QUATICE GATLINFACILITY TYPE:
740
ADDRESS:8601 SAN ROMOLO WAYTELEPHONE:
(657) 214-2241
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:6CENSUS: DATE:
03/16/2026
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Ukarjit Kaur
Celena SHerman		TIME COMPLETED:
03:44 PM
ALLEGATION(S):
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Staff does not provide adequate food service for resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley scheduled an office meeting with Licensee/Administrator Ukarjit to complete the complaint investigation into the allegation listed above. LPA Haley explained the reason for the office meeting upon Licensee’s arrival.

Regarding the allegation: Staff does not provide adequate food service for resident.

During the investigation, 3 of 4 individuals confirmed and/or provided information that supports the complaint allegation. During the investigation it was discovered that Resident 1 (R1) is diabetic and on a special diet. However, it was discovered, R1 has complained to facility staff they're still hungry and/or they did not have enough to eat. Accroding to medical records, R1 has had a 2-centimeter loss in arm circumference since December 2025.

Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026
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 3
Control Number 22-AS-20251223153341
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: MARIGOLD BOARD AND CARE
FACILITY NUMBER: 306006342
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2026
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings, and equipment.
This requirement is not being met as evidenced by:
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Licensee will read and review the regulation section, and licensee agrees to provide a detailed plan on how to ensure residents: (1) will receive the proper amount of food, and (2) be provided with additional food or snacks when requested. POC will be emailed to LPA Haley by 2:00PM on the POC due date.
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R1 has reported that they are still hungry after eating meals, they have been denied the opportunity to eat additional food, and has shown signs of weight loss.
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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: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20251223153341
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: MARIGOLD BOARD AND CARE
FACILITY NUMBER: 306006342
VISIT DATE: 03/16/2026
NARRATIVE
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Based on the evidence gathered through interviews, the preponderance of evidence standard has been met, therefore, the allegation above is found to be SUBSTANTIATED. A violation is being cited per California Code of Regulations Title 22.

An exit interview was conducted, and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3