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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005342
Report Date: 05/29/2026
Date Signed: 05/29/2026 04:36:02 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
04/30/2025 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250430084905
FACILITY NAME:CARE CELINE IFACILITY NUMBER:
306005342
ADMINISTRATOR:RICARDO DOUGUILESFACILITY TYPE:
740
ADDRESS:4381 CAMPHOR AVETELEPHONE:
(714) 801-5208
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:6CENSUS: 5DATE:
05/29/2026
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Licensee Cherry AguilaTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility is retaining a resident with unstageable pressure injuries without adequate level of care
Facility staff is medically restraining a resident
Facility staff hit a resident
INVESTIGATION FINDINGS:
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On May 29, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to deliver the complaint findings. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Licensee Cherry Aguila was also present and assisted on today's visit.

During the course of the investigation, the Department interviewed residents, interviewed staff, reviewed and obtained pertinent documents to this complaint such as resident records, resident medication records, and staff records. Regarding the allegation, facility is retaining a resident with unstageable pressure injuries without adequate level of care, the following has been concluded: It was alleged that the facility is retaining Resident #1 (R1) with unstageable pressure injuries without adequate level of care. The Department conducted a file review for R1 and observed that R1 was admitted to the facility on February 28, 2025. The Department also observed that R1 was also admitted under hospice care on February 28, 2025.
CONTINUED ON LIC9099-C
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
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-20250430084905
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: CARE CELINE I
FACILITY NUMBER: 306005342
VISIT DATE: 05/29/2026
NARRATIVE
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The Department observed that R1 remained under hospice care until she moved out of the facility on June 30, 2025. The Department reviewed the hospice care records and wound care specialist reports from R1. Per the hospice care records, R1 was admitted to the facility without any pressure injuries. On April 15, 2025, R1 was first observed to have wounds to her left and right thigh. On May 1, 2025, R1 was observed to have a third wound to her right thigh superior. Based on a review of the hospice care records and wound care specialist reports for R1, the three wounds were not classified as an unstageable pressure injuries. The three wounds were also not classified as stage three or stage four pressure injuries. R1 was receiving hospice care visits two or three times each week to treat the wounds. In addition, R1 was also receiving visits from a wound care specialist to treat the three wounds. Based on a review of records for R1, the facility was able to provide adequate care for R1 and was within the limitations of their license to continue retaining R1 as a resident of the facility. The Department conducted five staff interviews. The five staff interviewed confirmed that R1 had wounds on her body, however, the five staff denied that the wounds were unstageable.

Regarding the allegation, facility staff is medically restraining a resident, the following has been concluded: It was alleged that facility staff is medically restraining R1. The Department was unable to conduct an interview with R1 for this allegation, due to R1 passing away on October 2, 2025. During the investigation, the Department reviewed the medication and medication administration records for the residents of the facility, including for R1. The Department did not observe any medication errors or discrepancies in the medication records reviewed. The Department conducted five resident interviews. Two residents were unable to qualified for an interview due to their current cognitive conditions. However, the three other residents denied the allegation and reported that they have never been restrained by staff in any way. The Department also conducted three staff interviews for this allegation. Three out of the three staff interviewed denied the allegation and reported that residents have not been medically restrained in any way. During the investigation, the Department was unable to obtain any evidence to corroborate the allegation.

Regarding the allegation, facility staff hit a resident, the following has been concluded: It was alleged that facility staff hit R1 and Resident #2 (R2). The Department was unable to conduct an interview with R1 for this allegation, due to R1 passing away on October 2, 2025. The Department was also unable to conduct an interview with R2 for this complaint, due to R2 moving out of the facility on June 2, 2025. The Department conducted five resident interviews. Two residents were unable to qualified for an interview due to their current cognitive conditions. However, the three other residents denied the allegation and reported that they have never been hit by a staff. CONTINUED ON LIC9099-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250430084905
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: CARE CELINE I
FACILITY NUMBER: 306005342
VISIT DATE: 05/29/2026
NARRATIVE
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The Department conducted five staff interviews for this allegation. Five out of the five staff interviewed denied the allegation and reported that residents have never been hit by staff. The five staff also reported that they have never observed a staff hit a resident.

Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the three allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with Licensee Cherry Aguila and a copy of the report was provided to the facility at time of visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3