306006416-9-17-2026-22-AS-AINZ-DYE2FL-20260929172140

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006416
Report Date: 09/17/2026
Date Signed: 09/17/2026 03:57:41 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
04/29/2026 and conducted by Evaluator Michael Tea

COMPLAINT CONTROL NUMBER: 22-AS-20260429094244

FACILITY NAME:	ABUNDANT GRACE CARE VILLA		FACILITY NUMBER:	306006416
ADMINISTRATOR:	DOMPREH-MENSAH, THERESA		FACILITY TYPE:	740
ADDRESS:	9672 COLONY STREET		TELEPHONE:	(657) 201-3142
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	6	CENSUS: 4	DATE:	09/17/2026
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Theresa Domphreh-Mensah		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

- Staff isolated resident
- Staff handled resident roughly, causing injury
- Staff yelled at resident
- Staff did not provide adequate food service to resident, resulting in weight loss

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 conclude and deliver findings for a complaint investigation. LPA Tea was greeted and granted entry by Licensee (LE) Theresa Dompreh-Mensah and explained the purpose of the visit.

The Department received the complaint on April 29, 2026. LPA Tea conducted the initial 10-day visit on May 7, 2026. During the investigation, LPA Tea interviewed residents and facility staff and reviewed and collected relevant records and information.

It was alleged that staff isolated the resident. Resident 1 (R1) denied being isolated but reported that staff sometimes ignored them and did not provide the amount of attention they wanted. R1 reported spending time in their room and wanting staff to spend more time with them.

(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: 09/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026

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 6

Control Number 22-AS-20260429094244

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: ABUNDANT GRACE CARE VILLA	FACILITY NUMBER: 306006416
	VISIT DATE: 09/17/2026

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

R1's Responsible Party denied that R1 was isolated and reported that R1 preferred a private room, did not want to be bothered by others, and frequently wanted one-to-one attention. The Responsible Party also reported that R1 communicated with family by telephone and received visitors.

Four out of four staff interviewed denied isolating R1. Staff reported that R1 preferred privacy, frequently remained in their room or bed, received one-to-one care, and had visitors.

Records reviewed documented R1's contact with family and others while residing at the facility. Progress notes documented visits from R1's family and friend, telephone contact with family, and occasions when R1 spent time outside of their room. R1's Appraisal/Needs and Services Plan also identified socialization needs and directed staff to encourage social interaction and participation in activities.

It was alleged that staff handled resident roughly, causing injury. R1 reported that staff were rough with them during personal care, including changing and repositioning. R1 stated that staff pulled on them and caused them pain. R1's Responsible Party reported that R1 had complained to family that staff were rough with them but stated that they did not personally witness staff mistreat R1.

Four out of four staff interviewed denied handling R1 roughly or causing injury. Staff reported that R1 required assistance with personal care, transfers, and repositioning. Three out of three residents interviewed denied witnessing staff handle R1 roughly. All three residents also reported that staff did not handle them roughly and described caregivers as gentle.

Medical records showed that R1 had significant physical limitations before admission to the facility, including left-sided weakness/paralysis related to a previous cerebrovascular accident and tenderness to the left posterior elbow. R1's Appraisal/Needs and Services Plan documented that R1 required assistance with transfers, repositioning, feeding, grooming, toileting, and other activities of daily living.

Records also documented complaints of shoulder pain during R1's placement and that R1 was sent for medical evaluation. During one incident involving personal care and repositioning, R1 became upset and reported that staff had injured them. However, the records reviewed did not establish that R1 sustained an injury as a result of staff handling them roughly.
(Complaint Investigation Report continued on LIC9099-C)

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 22-AS-20260429094244

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: ABUNDANT GRACE CARE VILLA	FACILITY NUMBER: 306006416
	VISIT DATE: 09/17/2026

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

It was alleged that staff yelled at resident. R1 reported that staff yelled at them while they resided at the facility, including during personal care. R1's Responsible Party reported that R1 frequently complained about caregivers and how staff treated them. However, the Responsible Party stated that they did not personally witness staff yell at or mistreat R1.

Four out of four staff interviewed denied yelling at R1 and reported that staff attempted to meet R1's needs and requests. Staff reported that R1 sometimes became upset during personal care. One staff member reported being hard of hearing and stated that R1 and R1's family were aware of this. Two out of three residents interviewed reported that they had not witnessed staff yell at R1 or other residents. One resident reported hearing yelling but could not determine whether the yelling came from a staff member or a resident.

Facility records documented occasions when R1 became upset during personal care and repositioning. During one incident, R1 became upset while staff were providing care and made statements that they needed help and that staff wanted to harm them. The records did not establish that staff yelled at R1.

It was alleged that staff did not provide adequate food service to resident, resulting in weight loss. R1 reported concerns regarding food service at the facility. R1 stated that they were a slow eater and that staff sometimes rushed them or removed their food before they finished eating. R1 also reported that breakfast portions were sometimes too small and that family occasionally brought them outside food. However, R1 denied losing weight while residing at the facility.

Four out of four staff interviewed denied withholding food or failing to provide adequate food to R1. Staff reported that meals were provided and that R1 received assistance with their nutritional needs. Staff also reported that R1's family sometimes brought outside food for R1, including fast food and snack foods that staff considered less nutritious.

Two out of three residents interviewed reported being satisfied with the facility's food service. One resident reported that the food was good but felt the portions were sometimes not enough. During the visit, LPA Tea observed a sufficient supply of perishable and nonperishable food at the facility.

Records reviewed documented R1's food and fluid intake during their placement, including multiple entries
(Complaint Investigation Report continued on LIC9099-C)

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 22-AS-20260429094244

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: ABUNDANT GRACE CARE VILLA	FACILITY NUMBER: 306006416
	VISIT DATE: 09/17/2026

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

showing that R1 ate meals and drank fluids. Records also documented occasions when R1 ate outside of their room. R1's Appraisal/Needs and Services Plan identified the need for assistance with feeding and directed staff to monitor R1's nutritional intake.

Although R1 reported concerns regarding food portions, being rushed, and food being removed before they finished eating, the investigation did not establish that R1 experienced weight loss due to inadequate food service.

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

No deficiencies are being cited regarding the above allegations at this time.

An exit interview was conducted with Licensee Theresa Dompreh-Mensah, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 6

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
04/29/2026 and conducted by Evaluator Michael Tea

COMPLAINT CONTROL NUMBER: 22-AS-20260429094244

FACILITY NAME:	ABUNDANT GRACE CARE VILLA		FACILITY NUMBER:	306006416
ADMINISTRATOR:	DOMPREH-MENSAH, THERESA		FACILITY TYPE:	740
ADDRESS:	9672 COLONY STREET		TELEPHONE:	(657) 201-3142
CITY:	ANAHEIM	STATE:CA	ZIP CODE:	92804
CAPACITY:	6	CENSUS: 4	DATE:	09/17/2026
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Theresa Domphreh-Mensah		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

- Staff housed resident in an unlicensed building

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 conclude and deliver findings for a complaint investigation. LPA Tea was greeted and granted entry by Licensee (LE) Theresa Dompreh-Mensah and explained the purpose of the visit.

The Department received the complaint on April 29, 2026. LPA Tea conducted the initial 10-day visit on May 7, 2026. During the investigation, LPA Tea interviewed residents and facility staff and reviewed relevant records and information.

It was alleged that staff housed Resident 1 (R1) in an unlicensed building. The investigation revealed that R1 initially resided at Abundant Grace Care Villa 2, located at 9682 Colony Drive, Anaheim, CA 92804, Facility Number 306006646. Abundant Grace Care Villa 2 is located on the same property as another facility

(Complaint Investigation Report continued on LIC9099C)

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026

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

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 22-AS-20260429094244

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: ABUNDANT GRACE CARE VILLA	FACILITY NUMBER: 306006416
	VISIT DATE: 09/17/2026

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

but has a separate address and license. The facility is licensed to serve four non-ambulatory residents, all of whom may be bedridden, and has a hospice waiver for four residents.

R1's Responsible Party reported that R1 was later moved to the main facility during their placement but did not provide information showing that R1 had been housed in an unlicensed building.

Licensee James Mensah denied that R1 was housed in an unlicensed building and reported that R1 initially resided at a licensed facility. Four out of four staff interviewed also reported that the building where R1 initially resided was licensed.

During the investigation, LPA Tea observed a valid facility license at Abundant Grace Care Villa 2. LPA Tea also reviewed Department licensing records and verified that the facility was licensed. Therefore, the investigation established that R1 was not housed in an unlicensed building.

Based on interviews conducted, observations, and Department records reviewed, the allegation that staff housed R1 in an unlicensed building is determined to be UNFOUNDED, meaning that the allegation was false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted with Licensee Theresa Dompreh-Mensah, and a copy of this report was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 6