306005316-5-11-2026-22-AS-LMOA-DV3QF3-20260615120717

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005316
Report Date: 05/11/2026
Date Signed: 05/11/2026 02:47:02 PM

Unsubstantiated

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
05/01/2026 and conducted by Evaluator Edward Kim

COMPLAINT CONTROL NUMBER: 22-AS-20260501094216

FACILITY NAME:	ANAHEIM CROWN PLAZA		FACILITY NUMBER:	306005316
ADMINISTRATOR:	GERARDO RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	641 SOUTH BEACH BLVD		TELEPHONE:	(714) 827-7007
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	200	CENSUS: 143	DATE:	05/11/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Administrator- Gerardo Rodriguez		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not give resident personal belonging.
Staff did not provide resident with comfortable accommodation.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On May 11, 2026, 8:45 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced initial complaint visit at the facility for the above allegations. LPA Kim met with Administrator Gerardo Rodriguez and explained the purpose of the visit.

LPA Kim conducted a physical plant tour inside and outside of the facility and no concerns were observed. LPA Kim reviewed three resident’s record, which include: Admission Agreement, Identification and Emergency Information, Physician's Report, Needs and Services Plans/Reappraisal, Incident reports, and other pertinent records.

The investigation revealed the following:

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2026

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 22-AS-20260501094216

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: ANAHEIM CROWN PLAZA	FACILITY NUMBER: 306005316
	VISIT DATE: 05/11/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Staff did not give resident personal belonging
It is alleged a resident #1 (R1) left their walker, wheelchair and luggage at the facility and the facility stole R1’s walker, wheelchair, and luggage. It is alleged the R1 has tried communicating with the facility regarding the whereabouts of their belongings and the facility will not answer or return their phone calls.

Based on record review, R1’s admission agreement stated they were admitted to the facility on January 23, 2025. R1’s LIC621 was left blank and does not list a wheelchair, walker, or luggage. On November 21, 2025, R1 wrote a 30-day notice that they were leaving the facility on December 31, 2025. The facility move out form was filled out and signed by R1 stating that R1 has returned the keys, removed all of their belongings and cleaned the room, and all remaining belongings can be donated/disposed of. In a handwritten letter by R1 dated December 29, 2025, R1 stated R2 could have their suitcase, recliner chair, small table with chair, 43-inch TV, and miscellaneous stuff. There is no mention of R1’s wheelchair or walker to be in care or given to R2.

Based on interviews, Staff #1 (S1) stated that prior to R1 leaving the facility, that R1 signed that all belongings were accounted for. S1 stated that the R1 did not ask the facility to watch over their stuff or come into agreement to hold onto R1’s belongings. S1 has not been contacted by R1 about the situation with their belongings. S2 stated they were contacted and explained to R1 that they left the facility on their wheelchair. S1 and S2 stated the resident left the facility on their wheelchair. Based on observation, LPA did not observe R1’s wheelchair, walker, or luggage in the facility.

Based on information gathered, there is no sufficient evidence to corroborate the above allegation.

Allegation: Staff did not provide resident with comfortable accommodation
It is alleged R1’s mattress was uncomfortable and that it made their back hurt. R1 complained to staff about the mattress, however, staff did not address the matter.

Based on interviews conducted, two out of three residents and two out of two staff denied the allegation. One out of three residents confirmed the allegation. Two out of three residents stated they have not heard issues about a mattress causing back pain for R1. R2 stated they recall R1 having back pain but does not recall R1 stating a faulty mattress caused it.
Continued on LIC9099C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20260501094216

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: ANAHEIM CROWN PLAZA	FACILITY NUMBER: 306005316
	VISIT DATE: 05/11/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

S1 stated that if any resident requested a new mattress or reported a problem with the mattress, the facility would replace it and provide a new mattress. S1 stated that the Licensee told them that they replaced R1's mattress, but could not provide the record of when it was replace. Based on record review, there is no record of R1 communicating the faulty mattress prior to written correspondence on November 21, 2025, and December 3, 2025. Based on observation, LPA observed R1’s mattress was in good condition. There was no issues showing that the mattress was faulty or in poor condition.

Based on information gathered, there is not sufficient evidence to corroborate the above allegation.

Based on records review, interviews, and observations, LPA did not find sufficient evidence to support the above allegations Staff did not give resident personal belonging and Staff did not provide resident with comfortable accommodation.. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was conducted a copy of the report was provided to Administrator Gerardo Rodriguez.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3