306006480-4-21-2026-22-AS-APAO-DTHV89-20260426161223

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006480
Report Date: 04/21/2026
Date Signed: 04/21/2026 04:56:53 PM

Unfounded

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
04/14/2026 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20260414100151

FACILITY NAME:	AMARI HOUSE		FACILITY NUMBER:	306006480
ADMINISTRATOR:	MOSHARRAF, MUSHAIRA		FACILITY TYPE:	740
ADDRESS:	515 N HARCOURT ST		TELEPHONE:	(562) 377-4764
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	6	CENSUS: 2	DATE:	04/21/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Mushaira Mosharraf, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not change resident for an extended period of time
Staff does not provide meals to resident
Staff does not ensure resident is hydrated

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by Staff #1 at 1pm. LPA met with Administrator Mushaira Mosharraf and Administrative Designee Shaira Mosharraf and explained the purpose of the visit.

The facility recently opened on March 25, 2026 and has two residents and two staff members. On April 11, 2026 the Power of Attorney (POA) for Resident #1 (R1) requested R1 be sent out to the Emergency Room. At time of incident, Occupational Therapist (OT) had been with R1 when POA made the request. Paramedics assessed and asked staff why they were called. Administrator stated POA called and wanted R1 transported to Anaheim Regional Center. R1 returned to facility on April 13, 2026 and POA contacted . Anaheim Police Department to conduct a welfare check on April 13, 2026 at 11:29pm. AD spoke with PD during the welfare check and resident was not in distress and was fast asleep. No problems were noted.
(Continued on LIC 9099-C)

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

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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Control Number 22-AS-20260414100151

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: AMARI HOUSE	FACILITY NUMBER: 306006480
	VISIT DATE: 04/21/2026

NARRATIVE

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(Continued from LIC 9099)

LPA reviewed two of two resident files and obtained copies of the following: Resident Admissions Agreements, Medical Assessments, Appraisal Needs and Services Plans, and Durable Power of Attorney Paperwork. LPA also reviewed Unusual Incident Reports filed with the Department on March 11th and March 13th regarding Resident #1 (R1) and a SOC 341 Report of Suspected Elder Abuse received by the Department on April 13, 2026. Facility cross reported to Adult Protective Services (APS), Long Term Care Ombudsman (LTCO) and Anaheim PD LPA also reviewed discharge instructions from Anaheim Regional Center.

It was alleged that Staff did not change resident for an extended period of time. LPA interviewed two of two residents to inquire if they are not being changed in a timely manner. Two of two residents denied the allegation. One resident verbalized they were changed often by staff. Staff stated Resident #1 (R1) received showers by a bath aide one a week but is sponge bathed every day. Staff also stated residents are changed three to four times per day. Resident #1 (R1) is non-ambulatory and requires assistance with Activities Daily Living (ADL) per Medical Assessment dated March 26, 2026 with a diagnosis of dysphagia and mild cognitive impairment.. Staff stated residents are checked prior to breakfast, after lunch, after dinner and prior to going to bed with additional checks, as needed. Three of three staff denied this allegation. The allegation that staff was not changed for two weeks was Unfounded.

LPA investigated the allegation that Staff does not provide meals to resident. LPA interviewed two of two residents. When asked if they were fed, two of two residents stated they were being fed meals. Resident #1 (R1) stated to LPA that, Yes, they were being fed meals and that they were nothing fancy but keeps R1 alive. LPA asked if R1 would like more food to which R1 stated they were fed enough food. LPA observed in the medical assessment that R1 is to be fed a pureed diet and staff confirmed R1 must be fed by the staff. Upon interview with staff, three of three staff denied the allegation that staff does not provide meals to the resident. The primary staff member who is with the resident stated they prepare the meals for both residents and hand feeds each resident. Staff prepares meals for breakfast, lunch, dinner and snacks. The allegation that staff does not provide meals to residents is Unfounded.

It was also alleged that Staff does not ensure resident is hydrated. LPA observed two of two residents with clear water bottles with straws. Staff constantly remind residents to drink water and monitor the clear water
(Continued on LIC 9099-C1)

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20260414100151

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: AMARI HOUSE	FACILITY NUMBER: 306006480
	VISIT DATE: 04/21/2026

NARRATIVE

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(Continued from LIC 9099-C)

bottles One resident has a pink rimmed bottle, the other has a blue rimmed bottle. Water is readily available to residents at their bedside and on their person if they are moving about the facility. Interview of three of three staff stated both residents drink approximately two and a half water bottles. Each water container is approximately 16 ounces so residents receive approximately 32-40 ounces of water daily. Per interviews with residents, two of two residents confirmed they have access to water. The allegation that staff does not ensure resident is hydrated is Unfounded.

Based on LPA observations, record review and interviews, the allegations that Staff did not change resident for an extended period of time, Staff does not provide meals to resident and Staff does not ensure resident is hydrated are Unfounded. The allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted with Administrator Mushaira Mosharraf and Administrative Designee Shaira Mosharraf and copy of this report, and LIC 811 were provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

LIC9099 (FAS) - (06/04)

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