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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006373
Report Date: 10/21/2025
Date Signed: 10/21/2025 10:18:01 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/16/2025 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20250116094644
FACILITY NAME:BARR SENIOR COURTYARD IFACILITY NUMBER:
306006373
ADMINISTRATOR:PONTOY,MARETIESFACILITY TYPE:
740
ADDRESS:8552 BARR LANETELEPHONE:
(626) 561-8029
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:6CENSUS: 6DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Isabel VargasTIME COMPLETED:
10:40 AM
ALLEGATION(S):
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Staff did not ensure resident received sufficient food service
Staff did not maintain complete records for resident
Staff did not communicate with resident's authorized representative regarding care needs in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to continue the investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility and interviewed staff as well as reviewed and obtained pertinent documentation such as physician report. Regarding the allegations that staff did not ensure resident received sufficient food service, staff did not maintain complete records for resident and staff did not communicate with resident's authorized representative regarding care needs in a timely manner, the investigation revealed the following: Garden Park Care Center discharge summary for Resident 1 (R1) dated 11/18/2024 indicates R1 is on a regular diet, pureed texture with moderately thickened liquids. Two out of two staff state resident was eating a pureed diet supplemented by protein shakes. LPA observed photos of pureed meals documented for the resident's family member. Two out of two staff deny feeding the resident protein shakes only. LPA observed residents eating breakfast during the visit and food served was appropriate. CONTINUED ON LIC 9099C DATED 10/21/2025
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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-20250116094644
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: BARR SENIOR COURTYARD I
FACILITY NUMBER: 306006373
VISIT DATE: 10/21/2025
NARRATIVE
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Physician order dated 10/20/2023 shows an order for a hospital bed. Staff state the bed and wheelchair were ordered through Dr Pham and Legacy Home Health and authorization was not made by the staff. LPA reviewed a discharge letter dated 07/18/2024 from Dr Pham terminating services due to inappropriate behavior from R1's family member. After the discharge, R1 went under a different physician for care. R1's family member was non-responsive to LPA. Two out of two staff confirm speaking with R1's family member constantly regarding care. LPA reviewed text messages between facility and R1's family regarding obtaining emergency services for the resident in December 2024. Based on interviews conducted and record review, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2