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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006369
Report Date: 04/14/2025
Date Signed: 04/14/2025 11:35:54 AM

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
02/20/2025 and conducted by Evaluator RoseMarie Ruppert
COMPLAINT CONTROL NUMBER: 22-AS-20250220103503
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: 6DATE:
04/14/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Allan Manimbo, Administrative Designee (AD)TIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff left resident in soiled clothes/diapers for a period of time.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility to deliver findings for a complaint visit conducted on February 20, 2025. LPA was greeted and granted entry and spoke with Carla Ward, Administrator via phone. LPA met with Allan Manimbo, Administrator Designee.

LPA interviewed staff and residents regarding care provided and the length of time it took for staff to respond for toileting needs. Two residents stated staff come timely and check on them when they call. One resident toileted independently. LPA reviewed resident file and spoke with home health who visited twice a week. Home health nurse stated there is a resident log that shows how often residents are changed or turned and that it is being followed. Staff stated if residents call, they attend to them within fifteen minutes.

Although the above allegation may have happened there is not a preponderance of evidence to prove the alleged violation occurred; therefore, the allegation that the resident was left in soiled clothes/ diapers for a period of time is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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