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Facility Evaluation Report

Belmont Guests Retreat I, Yorba Linda10/27/2025Licence 306003397

Capacity6
Census2
Date signed10/27/2025 04:59:28 PM
Name of licensing program analystEdward Kim
Name of licensing program managerLourdes Montoya
The inspector’s account

On October 27, 2025, Licensing Program Analyst (LPA) Edward Kim conducted a case management deficiency visit unrelated to an allegation of complaint # 22-AS-20251022110928.

LPA interviewed Administrator (ADMIN) Elizabeth Mullins, who stated they submitted the LIC624A for a death report through mail on October 10, 2025. Per record review, As of October 27, 2025, LPA observed on the Serious Incident Report (SIR) OCRO portal that there was no death report submitted for R1 when they passed away. There is no record of the LIC624A being received within seven days of R1's death on October 7, 2025.

A deficiency was cited by Title 22 Division 8 Chapter 6.

An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Elizabeth Mullins.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction