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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006716
Report Date: 05/13/2026
Date Signed: 05/13/2026 05:19:27 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
05/06/2026 and conducted by Evaluator Jerome Haley
COMPLAINT CONTROL NUMBER: 22-AS-20260506093253
FACILITY NAME:CARE VITALEFACILITY NUMBER:
306006716
ADMINISTRATOR:GARCIA, JASMINFACILITY TYPE:
740
ADDRESS:7344 CHIPPEWA CIRCLETELEPHONE:
(657) 239-0364
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:6CENSUS: DATE:
05/13/2026
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Jasmin GarciaTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility illegally evicted resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint received May 6, 2026. LPA Haley was greeted by staff and explained the reason for the visit upon entry.

Regarding the allegation: Facility illegally evicted resident

During the investigation it was discovered, Resident 1 (R1) was sent to the hospital May 4, 2026, due to running out of medications. On May 5, 2026, the resident was scheduled to be discharged; however, there was either confusion or a refusal to reassess the resident prior to hospital discharge.

During an interview with Licensee/Administrator Jasmin Garcia, she confirmed, R1 did not return because the resident needed to be reassessed and possible need a higher level of care.
Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
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-20260506093253
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 VITALE
FACILITY NUMBER: 306006716
VISIT DATE: 05/13/2026
NARRATIVE
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Based on the evidence gathered during interviews, the preponderance of evidence standard has been met, therefore, the allegation above is found to be SUBSTANTIATED. A violation is being cited per California Code of Regulations Title 22.

An exit interview was conducted, and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260506093253
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 VITALE
FACILITY NUMBER: 306006716
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/15/2026
Section Cited
CCR
87224(a)
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87224 (a)Eviction Procedures -
The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty days written notice to the resident is required...This requirement was not met as evidenced by:
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Licensee/Administrator agrees to read and review regulation section 87224 Eviction Procedures, and send LPA Haley a signed statement of acknowledgement and understanding upon completion.
POC is due by 4:00pm on the POC due date, Friday, May 15, 2026.
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Based on interview confirmation, Resident (1) was not allowed to come back to the facility after a visit to the hospital on May 4, 2026. R1 was discharged from the hospital May 5, 2026.
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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: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
LIC9099 (FAS) - (06/04)
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