<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005496
Report Date: 06/12/2026
Date Signed: 06/12/2026 04:30:17 PM

Substantiated


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
06/03/2026 and conducted by Evaluator Michael Tea
COMPLAINT CONTROL NUMBER: 22-AS-20260603100004
FACILITY NAME:GENTLE SENIOR CAREFACILITY NUMBER:
306005496
ADMINISTRATOR:MIRABUENO, MARIA PRICILLAFACILITY TYPE:
740
ADDRESS:4193 TERESA AVETELEPHONE:
(213) 446-1695
CITY:CYPRESSSTATE: CAZIP CODE:
90630
CAPACITY:6CENSUS: 5DATE:
06/12/2026
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Eliseo ManuelTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Staff abandoned resident at the hospital
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit to investigate the above allegation. LPA Tea was greeted and granted entry by facility staff and explained the purpose of the visit. Lead Staff (LS) Eliseo Manuel arrived shortly to assist with the visit. LPA Tea also spoke with Administrator (AD) Priscilla Mirabueno by telephone, who stated that she was currently out of the country and was informed of the visit.

On June 3, 2026, the Department received a complaint alleging that staff abandoned a resident at the hospital. During the investigation, LPA reviewed hospital records, facility records, and conducted interviews.

The investigation revealed that Resident 1 (R1) was hospitalized and intended to return to the facility following discharge. Hospital records showed that medical social workers made multiple attempts to

(Complaint Report continued on LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
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 3
Control Number 22-AS-20260603100004
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: GENTLE SENIOR CARE
FACILITY NUMBER: 306005496
VISIT DATE: 06/12/2026
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
contact the facility regarding R1's return. Facility staff informed the hospital that only the administrator could approve R1's return and that the administrator was out of the country. Hospital staff were unable to reach the administrator and were also unable to leave messages for the manager because voicemail had not been set up.

During an interview, AD Mirabueno confirmed that she was outside of the country at the time and acknowledged that she did not have a designated substitute administrator available to make decisions in her absence. AD Mirabueno stated that she wanted to consult with a physician regarding R1's behaviors before approving their return to the facility. R1 remained hospitalized until they were readmitted to the facility on June 7, 2026. AD Mirabueno also confirmed that R1 had not been evicted and remained a resident of the facility.

Based on records reviewed and statements obtained during the investigation, the Department determined that the administrator failed to ensure adequate administrative coverage during her absence. As a result, no designated person was available to make decisions on behalf of the facility, which delayed R1's discharge from the hospital and return to the facility.

Therefore, the allegation that staff abandoned the resident at the hospital is determined to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of evidence standard has been met.

Pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited.

An exit interview was conducted with the facility. A copy of this report, the LIC 9099D, and appeal rights were provided to the facility.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
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 3
Control Number 22-AS-20260603100004
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: GENTLE SENIOR CARE
FACILITY NUMBER: 306005496
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2026
Section Cited
CCR
87405(a)
1
2
3
4
5
6
7
All facilities shall have a qualified and currently certified administrator...When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Facility shall develop a written plan identifying the designated back up administrator and outlining responsibilities during periods when the administrator is unavailable. POC will be submitted to LPA by the POC due date.
8
9
10
11
12
13
14
The facility failed to ensure administrative coverage during the administrator's absence. As a result, no designated person was available to make decisions regarding Resident 1's return to the facility, delaying the resident's discharge from the hospital and return to the facility.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3