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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920307
Report Date: 04/08/2026
Date Signed: 04/08/2026 10:08:06 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2026 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20260406204648
FACILITY NAME:HARMONY SENIOR HOME CARE, LLCFACILITY NUMBER:
345920307
ADMINISTRATOR:OMELIAN, IRYNAFACILITY TYPE:
740
ADDRESS:6405 BIG BEAR CTTELEPHONE:
(279) 236-9978
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 6DATE:
04/08/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Iryna OmelianTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Lack of staff supervision resulting in resident eloping from facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melissa Parks arrived on Wednesday April 8, 2026 unannounced to conduct a complaint visit regarding the above allegation. LPA met with Administrator Iryna and explained the purpose of the visit.

LPA interviewed the Administrator regarding the allegation. LPA learned the following: On April 3, 2026, R1 was seated outside with other residents and staff (s1). Another staff (s2) was inside assisting a resident with a shower. A home health nurse arrived, and s1 went inside to answer the door. While inside, s1 assisted the home health nurse with requested documents. S1 then went back outside and observed that R1 was not in the backyard. S1 began to search for R1 outside of the facility. The home health nurse's spouse was in the car in the driveway. This person observed R1 leaving. S1 contacted the Administrator, who then called 911. 911 let the Administrator know that they were contacted by someone in an adjacent neighborhood regarding R1. The police then escorted R1 to the Administrator. Per R1's physicians report, Resident (R1) is not able to leave the facility unassisted due to a diagnosis of Dementia.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
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 3
Control Number 59-AS-20260406204648
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HARMONY SENIOR HOME CARE, LLC
FACILITY NUMBER: 345920307
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/09/2026
Section Cited
CCR
87705(j)
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87705 Care of Persons with Dementia.
(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident.
This requirement was not met as evidenced by: Based on interview conducted and
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Facility installed a camera on 4/3/26 (after the incident) by the backyard. This camera notifies the Administrator (by phone) and an audible alarm for staff when there is activity by the gate. This deficiency was cleared at the time of the visit.
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documentation reviewed, the Licensee did not ensure that resident (R1) was not able to exit the facility (backyard gate), unassisted, on 4/3/26, which posed an immediate health and safety risk to residents in care. Resident was returned to the facility, uninjured, 20 minutes later.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20260406204648
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HARMONY SENIOR HOME CARE, LLC
FACILITY NUMBER: 345920307
VISIT DATE: 04/08/2026
NARRATIVE
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Based on the information detailed above, LPA finds the allegation to be substantiated. A finding that the allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on 9099-D.


Exit interview. Copy of report and appeal rights provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3