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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608971
Report Date: 12/09/2025
Date Signed: 06/10/2026 02:23:28 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/05/2025 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20251205084314
FACILITY NAME:GARDEN GROVE VILLAFACILITY NUMBER:
197608971
ADMINISTRATOR:MORALES, NEIL M.FACILITY TYPE:
740
ADDRESS:8051 GARDEN GROVE AVENUETELEPHONE:
(818) 448-6852
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:6CENSUS: 6DATE:
12/09/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Neil Morales, AdministratorTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to a resident.
Staff did not follow proper reporting requirements.
INVESTIGATION FINDINGS:
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This is an amendment to the original report issued on 12/09/2025 to correct the deficiency cited under Section 87211(a)(1)(D) to Section 87211(a)(2), Reporting Requirements. At 9:30 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannouced initial complaint visit to investigate the above stated allegations. LPA met with the Staff #1 (S1) Dell Morales AKA Delinia Morales and the Administrator was contacted via telephone. LPA explained the reason for the visit. The Administrator arrived at the facility at 10:20 AM.

During course of the investigation, interviews and record review were made. At 9:55, LPA requested resident and staff roster. At 10:05 AM, LPA requested copies of pertinent information which include, but not limited to Physician Report, Admission Agreement, Appraisal Needs and Services Plan and ect., relevant to the course of investigation. At approximately 10:15 AM, LPA conducted a physical plant tour. Between 10:20 AM to 1:15 PM LPA conducted an interview with the Administrator, two staff members, and four (4) out of six (6) residents who were avaliable at the facility. Continue on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
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 5
Control Number 31-AS-20251205084314
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GARDEN GROVE VILLA
FACILITY NUMBER: 197608971
VISIT DATE: 12/09/2025
NARRATIVE
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Staff did not provide adequate supervision to a resident.
The allegation stated that Resident #1 (R1) was found wandering outside the facility. It was also reported that R1 was unable to recall the address or phone number of the facility and is very hard of hearing. To investigate this allegation, LPA conducted interviews with the Administrator, Staff #1 (S1), and Staff #2 (S2). LPA was informed that R1 routinely left the facility without staff supervision. Additionally, staff acknowledged that they had previously allowed R1 to leave the facility unassisted, despite R1 having mild cognitive impairment and hearing loss. S2 also stated that they did not check on R1 after he/she left the facility. The Administrator confirmed that R1 often left the facility without supervision and that staff did not check on R1 because he/she would return later. LPA reviewed R1’s physician report and observed that, while R1 has some ability to leave the facility unassisted, the physician included precautions and conditions—such as carrying a phone and being familiar with the area—to ensure safety. Additionally, interviews were conducted with four out of six available residents, one of whom reported observing R1 leaving the facility unassisted.

During today's visit, LPA observed that two additional residents (R5 and R6), who are not permitted to leave the facility unassisted per physician orders, were found outside the facility without supervision and without the Administrator’s knowledge. R6 was out of the facility for approximately five hours (8:30 AM – 2:00 PM), and no report was made regarding the absence. Therefore, based on interviews, record reviews, and LPA's observation this allegation is Substantiated.



Staff did not follow proper reporting requirements.
It was alleged that the facility was not aware of R1 being out of the facility since 12/01/2025 at 4:00 PM and that no missing person report was made. To investigate this allegation, LPA conducted interviews with the Administrator, two (2) staff members, and residents; and reviewed facility records, physician reports, the incident report submitted to the Community Care Licensing Division (CCLD) on 12/03/25.

Interviews revealed that R1 left the facility on 12/01/2025 at approximately 4:00 PM to do his personal laundry; however, the facility did not become aware of R1’s whereabouts until a hospital contacted the facility between 9:00–10:00 AM on 12/02/2025. The Administrator further acknowledged that no missing person report was filed with local law enforcement, despite R1’s mild cognitive impairment.

Continue on LIC 9099C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20251205084314
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GARDEN GROVE VILLA
FACILITY NUMBER: 197608971
VISIT DATE: 12/09/2025
NARRATIVE
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Additionally, during today’s visit, LPA observed that R5 and R6—both of whom have physician orders indicating they cannot leave the facility unassisted—were not present in the facility. The Administrator was unable to provide the location or schedule for R5’s day program. Furthermore, R6 left the facility at 8:30 AM to “find a lawyer” and did not return until 2:00 PM, and no missing person report was filed for R6.

Based on interviews, observations, and record review, this allegation is SUBSTANTIATED.

Deficiencies issued and appeal rights explained.

Exit interview conducted and this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 31-AS-20251205084314
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GARDEN GROVE VILLA
FACILITY NUMBER: 197608971
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2025
Section Cited
CCR
87211(a)(2)
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87211(a) Each licensee shall furnish to the licensing agency... the following: (2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents..., shall be reported within 24 hours ... This requirement was not met as evidenced by:
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Administrator shall retrain all staff on 87211(a)(2) Reporting requirements for unusual incidents, including missing residents.Administrator shall implement a written procedure for immediate reporting of any resident absence or unusual incident.
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Based on interviews, observations, and record review, the licensee did not comply, by failing to notify the Department within 24 hours of an incident involving Resident #1 on 12/01/2025. This posed a potential health and safety risk to residents in care.
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Proof of staff training and a copy of the updated reporting procedure shall be submitted to LPA by the POC due date.
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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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20251205084314
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GARDEN GROVE VILLA
FACILITY NUMBER: 197608971
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
12/11/2025
Section Cited
CCR
87464(f)(1)
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87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).
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Administrator to conduct training on supervision requirements, provide documentation of staff retraining, and implement a check-out/check-in system. A proof of training to be submitted to LPA by the POC due date (12/11/2025).
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Based on interviews, observation and record review the licensee did not comply with the section cited by allowing residents with mild cognitive impairment and hearing loss were permitted to leave without supervision, contrary to physician precautions.
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Two residents who were not permitted to leave unassisted were still able to leave without staff awareness.
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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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5