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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005991
Report Date: 06/11/2026
Date Signed: 06/11/2026 03:43:29 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
05/18/2026 and conducted by Evaluator Michael Tea
COMPLAINT CONTROL NUMBER: 22-AS-20260518141019
FACILITY NAME:GARDEN GROVE GUEST HOME LLCFACILITY NUMBER:
306005991
ADMINISTRATOR:CONNOR KELLEYFACILITY TYPE:
740
ADDRESS:12882 SHACKELFORD LANETELEPHONE:
(714) 430-3534
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:47CENSUS: 46DATE:
06/11/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Paige RohrerTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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- Resident’s representative was not provided with a copy of the admission agreement
- Facility staff did not communicate with the authorized representative
- Facility staff did not ensure residents’ information was kept confidential
INVESTIGATION FINDINGS:
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On this date, Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit to conclude and deliver findings for a complaint investigation. LPA Tea was greeted and granted entry by facility staff and explained the purpose of the visit. Assistant Administrator (AA) Paige Rohrer arrived shortly to assist with the inspection.

The Department received a complaint on May 18, 2026. During the investigation, LPA Tea conducted interviews with residents, witnesses, and facility staff, and reviewed and collected pertinent records and information.

Regarding the allegation that the resident's representative was not provided with a copy of the admission agreement, interviews revealed that the responsible party received a copy of the admission agreement.
(Complaint Investigation Report continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2026
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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Control Number 22-AS-20260518141019
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: GARDEN GROVE GUEST HOME LLC
FACILITY NUMBER: 306005991
VISIT DATE: 06/11/2026
NARRATIVE
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Resident 1 (R1) confirmed that the family member received the agreement and later requested additional copies. Facility staff also stated that a copy was provided after the agreement was signed. AA Rohrer stated that after providing a signed copy of the admission agreement, she advises the responsible party to take the document to the Social Security Office to maximize the resident's benefits.

Regarding the allegation that facility staff did not communicate with the authorized representative, AA Rohrer stated that she regularly communicated with the responsible party and provided records showing ongoing communication. Facility staff confirmed that calls and messages from the responsible party were returned. Staff further stated that the responsible party frequently contacted the facility when AA Rohrer was not present, but she routinely returned the calls and maintained communication.

Regarding the allegation that facility staff did not ensure residents' information was kept confidential, a witness reported observing paperwork on a desk. However, AA Rohrer and facility staff stated that resident records were maintained inside the administrator's office and were accessible only to authorized personnel. Staff further stated that confidential documents did not leave the office and that the office door remained closed when not occupied by authorized staff.

Based on interviews conducted and records reviewed, there was insufficient evidence to prove or disprove the allegations. Therefore, the allegations mentioned above are deemed UNSUBSTANTIATED, meaning that although the allegations may have occurred or may be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

No deficiencies are being cited at this time. An exit interview was conducted with the facility, and a copy of this report and the Confidential Names List were provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2026
LIC9099 (FAS) - (06/04)
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