306005513-6-9-2026-22-AS-APAO-DUW53B-20260609193539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005513
Report Date: 05/23/2026
Date Signed: 06/09/2026 06:46:53 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
03/20/2023 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230320090137

FACILITY NAME:	CARMEL VILLAGE RETIREMENT COMMUNITY		FACILITY NUMBER:	306005513
ADMINISTRATOR:	CHARLES J EUSEY III		FACILITY TYPE:	740
ADDRESS:	17077 SAN MATEO		TELEPHONE:	(714) 962-6667
CITY:	FOUNTAIN VALLEY	STATE: CA	ZIP CODE:	92708
CAPACITY:	220	CENSUS: 187	DATE:	05/23/2026
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Mandy Taylor		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Facility staff is withholding care and supervision from resident
Unlawful eviction

INVESTIGATION FINDINGS:

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This report is being amended to reflect signatures.
On 05/23/2026, Licensing Program Analyst (LPA) Arielle Pascua conducted a complaint visit via telephone call regarding the complaint allegations above.
Current census was 187.
It was alleged that the facility staff is withholding care and supervision from resident and have issued an unlawful eviction. LPA Pascua attempted to contact former staff from this facility to obtain additional information, however, LPA Pascua was unable to reach staff as they were no longer employed by this facility. In addition, contact with current staff deny or have not been employed by the facility during the time of the complaint. A review of the facility records were also conducted. Based on interviews conducted and observation, the allegations are found to be UNSUBSTANTIATED, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report was provided via email for signature.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Emerita Curiel
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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