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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006369
Report Date: 03/17/2025
Date Signed: 03/17/2025 02:38:33 PM

Unsubstantiated


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
03/10/2025 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250310165438
FACILITY NAME:HILLS OF GOWDY, THEFACILITY NUMBER:
306006369
ADMINISTRATOR:SO, BRYANTFACILITY TYPE:
740
ADDRESS:23981 GOWDY AVENUETELEPHONE:
(714) 430-7672
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 5DATE:
03/17/2025
UNANNOUNCEDTIME BEGAN:
11:53 AM
MET WITH:Carla MirandaTIME COMPLETED:
03:34 PM
ALLEGATION(S):
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Staff did not provide assistance in meeting necessary medical and dental needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA was greeted and granted entry by staff. LPA met with Administrator Carla Miranda and explained the reason for the visit. LPA toured the facility and interviewed staff and residents. The investigation revealed the following. Resident 1 (R1) was scheduled for an appointment on February 20, 2025. The Administrator arranged for a staff member (S1) to take R1 to the appointment. S1 reported they were provided the address and took R1 to the appointment. R1 verified they were taken to the appointment but didn't make it inside, R1 reported that S1 didn't assist them out of the car and they ended up going back to the facility. S1 reported that R1 told him they were at the wrong location and refused to get out of the car. S1 stated they called the Administrator to speak to R1 but she couldn't convince R1 to get out of the car. The Administrator reported that the appointment was scheduled at a specialist, not R1's primary care physician (PCP) and that is why R1 didn't know the location and refused to get out of the car. The Administrator reported she was on the phone with R1 and they tried to convince R1 to attend the appointment.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
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 2
Control Number 22-AS-20250310165438
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: HILLS OF GOWDY, THE
FACILITY NUMBER: 306006369
VISIT DATE: 03/17/2025
NARRATIVE
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R1 reported she did talk to the Administrator but reported she was taken to the wrong location. A review of records shows R1's PCP is at a different location than the location of the specialist were the appointment was scheduled. R1 missed their appointment on February 20, 2025. The Administrator scheduled a new appointment after R1 missed their appointment. The witnesses involved reported conflicting information.

Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2