197803389-7-1-2026-11-AS-PMAA-DVTL49-20260709082509

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197803389
Report Date: 07/01/2026
Date Signed: 07/01/2026 11:04:31 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2026 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20260501095056

FACILITY NAME:	ORANGE COMMUNITY CARE		FACILITY NUMBER:	197803389
ADMINISTRATOR:	SAAFIR, AHMED		FACILITY TYPE:	735
ADDRESS:	2103 ORANGE AVENUE		TELEPHONE:	(562) 599-0856
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY:	36	CENSUS: 25	DATE:	07/01/2026
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Assistant Administrator - Nathaniel Stockard		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not ensure client took medication as prescribed.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 07/01/2026, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced subsequent complaint investigation visit to deliver an updated complaint investigation report for the allegation listed above. This report supersedes the report dated 05/07/2026. This report has been updated due to provide additional information. This report does not change the findings; the findings remain as “Substantiated”. LPA met with the Assistant Administrator, Nathaniel Stockard, and the purpose of the visit was explained.

On 05/07/2026, Licensing Program Analyst (LPA) Socorro Leandro initiated a complaint investigation regarding the allegation listed above. LPA met with the Administrator, Ahmed Saafir, and the purpose of the visit was explained. The LPA was allowed entry to the facility.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

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 11-AS-20260501095056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: ORANGE COMMUNITY CARE	FACILITY NUMBER: 197803389
	VISIT DATE: 07/01/2026

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

The investigation consisted of the following:

On 05/07/2026, interviews were conducted with Staff 1 (S1) to Staff 3 (S3), Cient 1 (C1), and Witness 1 (W1) and Medications alongside Medication Administration Records (MARs) were reviewed. Records gathered consisted of Plan of Operation, Resident Roster, Staff Roster, C1’s records, and other pertinent records were gathered. On 05/28/2026, interviews were conducted with Staff 4 (S4) and Witness 2 (W2) and records were reviewed. On 06/19/2026, Staff 5 (S5) submitted a Declaration report to the department.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 11-AS-20260501095056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: ORANGE COMMUNITY CARE	FACILITY NUMBER: 197803389
	VISIT DATE: 07/01/2026

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

The investigation revealed the following:

Allegation: “Staff did not ensure client took medication as prescribed”, it is being alleged that C1 did not take medication as prescribed.

Records reviewed of Plan Of Operation revealed the following:

“Self-administered Medication
WHAT YOU AT THIS FACILITY SHOULD DO WHEN:
1. Client/resident arrives with medications:
· Contact physician(s) to ensure physician is aware of all medications currently taken by the client/resident.
· Verify medications that are currently taken by the client/resident and instructions for disbursement.
· Inspect containers to ensure the labeling is accurate.
· Log medications accurately on forms for client/resident records.
· Discuss medications with the client/resident, if possible or the responsible person/authorized representative.
· Store medications in a locked cabinet, drawer, etc.
2. Medication is refilled:…
· Inspect containers to ensure all information on the label is correct.
· Note any changes in instructions and/or medication; for example, change in dosage, change to generic brand, etc.
· Log medication when received.
· Discuss any changes in medications with client/resident, responsible person/authorized representative and appropriate staff…
5. Client/resident refuses medications:…
· Refusal of medications should be documented on the client's/residents medication record and the prescribing physician contacted Immediately.”

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 11-AS-20260501095056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: ORANGE COMMUNITY CARE	FACILITY NUMBER: 197803389
	VISIT DATE: 07/01/2026

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

C1’s records reviewed revealed the following:

· Admission Agreement indicates that C1 was admitted to the facility on 03/03/2026.

· House Rules states “4. Medication can only be given as prescribed.” signed by C1 on 03/03/2026.

· C1’s March 2026 MAR was blank, document was not filled in by staff.

· Prescription states the following: "Ergocalciferol (vitamin D2) 1,250 mcg (50,000 unit) capsule (RxNorm code: 1367416) take 1 cap by mouth once weekly, with meal, for 12 weeks then discontinue; Qty/Dur: 12 Capsule; Refills:0; Total Fills: 1; Fill Status: Dispensed; Last Rx: 04/02/2026; Start Date: 04/02/2026.” (Provided by C1’s physician not the facility).

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 11-AS-20260501095056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: ORANGE COMMUNITY CARE	FACILITY NUMBER: 197803389
	VISIT DATE: 07/01/2026

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

C1’s Medications reviewed along with MARs from April to May 2026 revealed the following:

· There is no documentation or medication of the “Ergocalciferol (vitamin D2)” medication.
· Busprirone Tab 15 MG MAR do not have staff initials on 5:00 PM for 04/20/2026, 04/30/2026, 05/02/2026, 05/03/2026, 05/06/2026; the medication for those exact dates are not in bubble pack; there is no documentation as to why staff did not initial.
· Diclofenac Gel 1% MAR do not have staff initials on 5:00 PM for 04/16/2026, 04/20/2026, 04/25/2026 to 04/27/2026, 04/29/2026 to 05/06/2026 and for 9:00 PM on 04/20/2026, 04/20/2026, 04/25/2026 to 04/27/2026, 05/03/2026, and 05/06/2026; there is no documentation as to why staff did not initial.
· Gabapentin Cap 100 MG are documented twice on the MAR the first documentation is from 8:00 AM, 12:00 PM, and 5:00 PM the second is documented from 8:00 AM, 5:00 PM, and 9:00 PM; both have staff initials for each time frame and both are missing staff initials; there is no explanation as to why staff did not initial. The medication bubble pack for noon has medication still in the present for 04/09/2026, 04/13/2026, 04/14/2026, 04/15/2026, 04/17/2026 to 04/22/2026, 04/24/2026, 04/28/2026 to 04/30/2026, 05/04/2026 to 05/06/2026.
· Lidocaine Cream 3% do not have staff initials on 8:00 AM 05/01/2026, 12:00 PM 05/02/2026 to 05/03/2026, and 5:00 PM 04/20/2026, 04/25/2026 to 04/27/2026, 04/30/2026 to 05/04/2026, and 05/06/2026; there is no explanation as to why staff did not initial.
· Meloxicam Tab 7.5 MG do not have staff initials on 8:00 AM on 05/02/2026 to 05/03/2026, and 5:00 PM from 04/09/2026 to 05/06/2026; there is no explanation as to why staff did not initial. The morning bubble pack still had the medication for 04/09/2026 and the evening bubble pack still had the medication for 04/27/2026.
· There are seven other medications with discrepancies; ranging from medications not provided with no explanation as to why they were not provided to medications on MAR seen to be provided but when medication was checked they were present in the medication container.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 11-AS-20260501095056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: ORANGE COMMUNITY CARE	FACILITY NUMBER: 197803389
	VISIT DATE: 07/01/2026

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

Interviews conducted with S1 to S5, C1, W1 to W2 revealed the following:

S3 indicated that C1 provided them with medications on two separate occasions but they did not document medications. S1 and S2 indicated that they did not document medications that were provided to S3.

C1 indicated that they received a delivery of vitamin D medication along with medication documentation and provided said items to S3. Observations during the interview revealed that C1 received a text message on 04/03/2026 indicated that their medication had arrived. Furthermore, C1 indicated that they informed staff that vitamin D medication was to be taken once a week. C1 indicated that S5 gave them vitamin D medication every night and they took all twelve pills. Moreover, C1 indicated that they reminded staff that they are not supposed to take vitamin D daily furthermore, C1 question staff on what medication was been given to them. Additionally, C1 does not believe that staff read the directions of the medication

W1 a physician agrees with the allegation; furthermore, W1 indicated that they reached out to the facility due to medication errors. W1 indicated that the facility did not reach out to them previously.

S4 indicated that they work in the kitchen and they only provide medications to clients when the facility is short staffed. Furthermore, S1 indicated that they are unaware if C1 takes vitamin D medication.

S5 submitted declaration indicating that they did not provide “Ergocalciferol (vitamin D) medication to C1 and they provided medication to C1 during “morning/lunch/dinner/bedtime”.

W2 stated the following, C1 received a delivery of medication on 04/03/2026; seven medications which included vitamin D medication along with medication instructions.

Substantiated: Based on observations, interviews and record reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Licensee/Administrator, Ahmed Saafir.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 6