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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 05:16:26 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
02/17/2026 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260217104121
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:
03:45 PM
MET WITH:Ukarjit Kaur
Celena Sherman 		TIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility did not accept resident after seeking medical attention.
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: Facility did not accept resident after seeking medical attention.

During the investigation 4 individuals confirmed the complaint allegation. Durin interviews it was discovered that Resident 1 (R1) was sent to the hospital on Friday, February 13, 2026. Buena Park Police and Adult Protective Services responded to the facility regarding concerns about R1. Facility staff was in communication with Hospital staff in regards to treatment for R1 and a possible return to the facility. During the investigation it was discovered, on Monday, February 16, 2025, R1 was ready to be discharged and sent back to the facility. However, when R1 made it back to the facility, R1 was not accepted and/or not allowed to return.

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-20260217104121
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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It is unclear if facility staff answered the door when R1 was returned via ambulance on Monday, February 16, 2026; however, R1 was not allowed back inside and was eventually sent back to the hospital while hospital staff looked for placement for the R1.

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: 2 of 3
Control Number 22-AS-20260217104121
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
87224(a)
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87224 Eviction Procedures
(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thrity (30) days written notice is required except as otherwise specified in paragraph (5).
This requirement is not being met as evidenced by:
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Licensee will read and review regulation section 87224 and email LPA Haley a signed statement of acknowledgement and understanding.
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R1 was not accepted back by facility staff after being released from the hospital. R1 was eventually sent back to the hospital and never returned to the facility.
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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: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3