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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006369
Report Date: 04/24/2025
Date Signed: 04/24/2025 10:07:02 AM

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
02/20/2025 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:
04/24/2025
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Carla Ward, AdministratorTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is not providing a refund upon resident’s death.
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 regarding a complaint. LPA was greeted and granted entry at 9:33am. LPA met with Carla Ward, Administrator. The facility has six residents in care.

LPA explained to Administrator that the purpose of the visit was to amend an LIC 9099-D delivered on February 20, 2025 regarding a substantiated finding. An exit interview was conducted with Administrator Carla Ward and a copy of the reports were provided to the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
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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