306005453-6-13-2026-22-AS-AORZ-DV4QFR-20260616120821

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005453
Report Date: 06/12/2026
Date Signed: 06/13/2026 05:33:13 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
03/16/2026 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20260316072225

FACILITY NAME:	SILVER LINING RESIDENTIAL CARE		FACILITY NUMBER:	306005453
ADMINISTRATOR:	FADDOUL, LACY		FACILITY TYPE:	740
ADDRESS:	1243 N. BROOKHURST STREET		TELEPHONE:	(661) 810-7293
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	14	CENSUS: 7	DATE:	06/12/2026
		UNANNOUNCED	TIME BEGAN:	12:33 PM
MET WITH:	Miriam Esquivel		TIME COMPLETED:	04:28 PM

ALLEGATION(S):

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1-Faciity not providing activities to residents
2-Facility staff not handling residents medical appointments timely
3-Facility not providing variety of meals
4-residents being overmedicated
5-Facility is over resident capacity
6-Staff does not know how to verbally communicate with residents
7-Facility Staff did not report incident to responsible party
8-Licensee is not responding to responsible party
9-Resident sustained injuries from lack of care & supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver findings to the above-mentioned allegations. Upon arrival, LPA was greeted and granted entry by office manager, Miriam Esquivel. and explained the purpose of the visit.
The Department received a complaint on 03/16/2026, and During the investigation, LPA reviewed records relevant to the allegations, including the complaint report, R1’s 2026 medical records, facility fire clearance,, facility menu, and facility activity calendar. LPA interviewed three staff members. LPA also attempted to interview three residents; however, LPA was unable to obtain relevant information due to the residents’ cognitive ability. . LPA attempted to contact the reporting party on 06/02/2026, 06/04/2026, and 06/12/2026; however, LPA was unable to reach the reporting party. LPA did not leave a voicemail due to the instruction documented in the complaint report, which stated not to leave a voicemail and to call again if the reporting party could not be reached.
{***CONTINUE9099C***}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

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 4

Control Number 22-AS-20260316072225

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: SILVER LINING RESIDENTIAL CARE	FACILITY NUMBER: 306005453
	VISIT DATE: 06/12/2026

NARRATIVE

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Regarding the allegation that “Resident sustained injuries from lack of care and supervision,” LPA interviewed three staff regarding this allegation, and three of three staff denied that R1 sustained injuries as a result of neglect, lack of care, or lack of supervision by facility staff. For this allegation, LPA reviewed R1’s 2026 physician report, including skin observation notes, nurse practitioner notes, home health follow-up notes, physical therapy notes, and documented change-of-condition notes. The reviewed records documented that R1 had left eye ecchymosis on 01/19/2026, bumps on the top of the head on 02/06/2026 and 02/21/2026, yellow discoloration to the sides of the face on 03/17/2026, and a raised area to the upper right side of the back on 03/21/2026. The reviewed records also documented that the nurse practitioner was notified, monitoring and follow-up were documented, and the nurse practitioner advised on 03/17/2026 that the yellow discoloration appeared to be a normal healing bruise. The records did not establish that R1’s injuries or skin concerns were caused by lack of care or supervision by facility staff. Regarding the allegation that “Licensee is not responding to responsible party,” LPA interviewed three staff regarding this allegation, and three of three staff denied that the licensee failed to respond to R1’s responsible party. For this allegation, LPA reviewed the complaint report and R1’s 2026 physician report, including documentation related to responsible party communication. Records dated 03/13/2026 documented that facility staff communicated with R1’s responsible party regarding R1’s son’s visit and provided updates regarding R1’s home health and physical therapy services. LPA also attempted to contact the reporting party on 06/02/2026, 06/04/2026, and 06/12/2026; however, LPA was unable to reach the reporting party and did not leave a voicemail due to the complaint instruction not to leave one. Regarding the allegation that “Facility staff did not report incident to responsible party,” LPA interviewed three staff regarding this allegation, and three of three staff denied that facility staff failed to report an incident or change in condition to R1’s responsible party. For this allegation, LPA reviewed R1’s 2026 physician report, including responsible party communication notes, nurse practitioner notification notes, change-of-condition notes, and medical follow-up documentation. Records reviewed documented that the nurse practitioner was notified regarding multiple changes in condition, including entries dated 01/07/2026, 02/06/2026, 02/21/2026, 03/10/2026, 03/17/2026, 03/21/2026, 05/15/2026, 05/21/2026, 05/26/2026, and 06/11/2026. {***CONTINUE9099C***}

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 22-AS-20260316072225

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: SILVER LINING RESIDENTIAL CARE	FACILITY NUMBER: 306005453
	VISIT DATE: 06/12/2026

NARRATIVE

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Records dated 03/13/2026 also documented communication with R1’s responsible party regarding R1’s son’s visit and updates related to home health and physical therapy services. Regarding the allegation that “Staff does not know how to verbally communicate with residents,” LPA interviewed three staff regarding this allegation, and three of three staff denied that staff were unable to verbally communicate with residents. LPA attempted to interview three residents; however, LPA was unable to obtain relevant information due to the residents’ cognitive ability. For this allegation, LPA reviewed R1’s 2026 physician report , including documentation related to R1’s diagnosis, behavior changes, communication with medical providers, and coordination with outside services. The reviewed records documented that R1 had memory impairment and episodes of agitation, yelling, and disrupted sleep. However, records also documented that staff communicated with the nurse practitioner, home health, physical therapy, laboratory services, podiatry, equipment providers, and R1’s responsible party regarding R1’s needs. Regarding the allegation that “Facility is over resident capacity”, LPA reviewed the facility fire clearance and facility census information. The fire clearance documented that the facility is approved for six ambulatory residents and eight non-ambulatory residents. At the time of the visit, there were seven total residents in care. Based on the fire clearance reviewed, the number of residents in care did not exceed the facility’s approved capacity. Regarding the allegation that “Residents being overmedicated,” LPA interviewed three staff regarding this allegation, and three of three staff denied that R1 or other residents were being overmedicated. For this allegation, LPA reviewed R1’s 2026 physician report, including medication review notes, nurse practitioner medication orders, home health medication review notes, and medication change documentation. LPA reviewed R1’s Medication Administration Record (MAR) The records reviewed did not establish that R1 or any other resident was administered medication outside of physician orders. Regarding the allegation that “Facility not providing variety of meals,” LPA interviewed three staff regarding this allegation, and three of three staff denied the allegation. LPA reviewed the facility menu. The facility menu documented planned meals for Monday through Sunday, including breakfast, lunch, dinner, and snacks. The menu reflected a variety of food items, including hot and cold cereal, eggs, toast, pancakes, bacon, muffins, pizza, salad, macaroni and cheese, sandwiches, vegetables, soup, burritos, tacos, spaghetti, turkey, mashed potatoes and steak,

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20260316072225

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: SILVER LINING RESIDENTIAL CARE	FACILITY NUMBER: 306005453
	VISIT DATE: 06/12/2026

NARRATIVE

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LPA also observed residents having breakfast and lunch during this visit, and observed the facility following the menu. Regarding the allegation that “Facility staff not handling resident’s medical appointments timely,” LPA interviewed three staff regarding this allegation, and three of three staff denied the allegation. LPA reviewed R1’s 2026 Facility Notes, including nurse practitioner visit notes, home health records, and change-of-condition follow-up notes. Records reviewed documented nurse practitioner follow-up, home health enrollment and assessment, laboratory services, podiatry services, physical therapy services from 03/09/2026 through 04/29/2026, and equipment follow-up on 03/05/2026. The records reviewed did not establish that facility staff failed to handle R1’s medical appointments or medical follow-up in a timely manner. Regarding the allegation that “Facility not providing activities to residents,” LPA interviewed three staff regarding this allegation, and three of three staff denied the allegation. For this allegation, LPA reviewed the complaint report, R1’s 2026 medical flow sheet, and the facility activity calendar. The facility activity calendar documented planned activities, including morning news, bean bag toss, chair exercise, coffee talk, morning stretch, game day, game show, walk to the park, resident choice days, reading/free time, ice cream social, ring toss, current events, bingo, horse shoes, community center outing, shopping day, movie day, painting/coloring, and hairdresser day. Records also documented that R1 received physical therapy and exercise-related services, including walking with a walker, gait belt-assisted walking, chair exercises, walking on the outside patio, and transfer practice on dates including 03/12/2026, 03/17/2026, 03/19/2026, 03/24/2026, 03/31/2026, 04/07/2026, and 04/23/2026. The records reviewed did not establish that the facility failed to provide activities to residents. LPA also tried to interview R1 regarding all the above-mentioned allegations, but R1 refused to be interviewed. Based on interviews conducted, attempted resident interviews, attempted reporting party contacts, and records reviewed, the Department does not have a preponderance of evidence to prove that the alleged violations occurred. Therefore, the allegations are Unsubstantiated. Although the allegations may have happened or could be valid, there is not a preponderance of evidence to prove or disprove the allegations. No deficiencies were cited during today’s visit. An exit interview was conducted, and a copy of this report was provided Office Manager.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026

LIC9099 (FAS) - (06/04)

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