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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003651
Report Date: 07/27/2023
Date Signed: 07/27/2023 04:28:08 PM

Unfounded


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
05/26/2023 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230526155220
FACILITY NAME:COMFORT COTTAGES #1FACILITY NUMBER:
306003651
ADMINISTRATOR:FAROOQ RASHIDFACILITY TYPE:
740
ADDRESS:25231 MACKENZIETELEPHONE:
(949) 584-7083
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:6CENSUS: 4DATE:
07/27/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Farooq Rashid, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff deny resident visitors

Staff are not ensuring that resident's dental hygiene needs are not being met

Staff isolates resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the four allegations listed above. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit. Administrator Farooq Rashid, LVN was notified of the visit via telephone and arrived shortly afterwards to assist with the visit.

An initial investigation visit was conducted by LPA Patricia Velazquez on June 2, 2023. LPA Velazquez reviewed and obtained copies of facility, resident, and staff records. LPA Velazquez also conducted interviews with residents and staff. Additional documentation was provided and added to the investigation file.

LPA Saborit-Guasch followed up and conducted an additional visit, touring the physical plant with administrator along with conducting an additional witness interview.
CONTINUED ON FORM LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
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 4
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
05/26/2023 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230526155220

FACILITY NAME:COMFORT COTTAGES #1FACILITY NUMBER:
306003651
ADMINISTRATOR:FAROOQ RASHIDFACILITY TYPE:
740
ADDRESS:25231 MACKENZIETELEPHONE:
(949) 584-7083
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:6CENSUS: 4DATE:
07/27/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Farooq Rashid, AdministratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not afford resident with privacy
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the four allegations listed above. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit. Administrator Farooq Rashid, LVN was notified of the visit via telephone and arrived shortly afterwards to assist with the visit.

An initial investigation visit was conducted by LPA Patricia Velazquez on June 2, 2023. LPA Velazquez reviewed and obtained copies of facility, resident, and staff records. LPA Velazquez also conducted interviews with residents and staff. Additional documentation was provided and added to the investigation file.

LPA Saborit-Guasch followed up and conducted an additional visit, touring the physical plant with administrator along with conducting an additional witness interview.
CONTINUED ON FORM LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20230526155220
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: COMFORT COTTAGES #1
FACILITY NUMBER: 306003651
VISIT DATE: 07/27/2023
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
CONTINUED FROM FORM LIC9099-A

Regarding the allegation that Staff do not afford resident with privacy, the following has been concluded: Based on interviews with staff, residents and witnesses, facility policy is to provide as much privacy as possible to residents during visits, phone calls and video calls with their friends and families. Instances of staff needing to intervene during the conversations were documented but were explained by the necessity to preserve resident R1's welfare and health condition. As a result, this allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or may be valid; there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided to facility administrator.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 22-AS-20230526155220
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: COMFORT COTTAGES #1
FACILITY NUMBER: 306003651
VISIT DATE: 07/27/2023
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
CONTINUED FROM FORM LIC9099

Regarding the allegation that Staff deny resident visitors, the following has been concluded: Interviews conducted with two of the four residents present at the facility confirmed that friends and family were free to visit the facility at their convenience. Records of the facility sign-in log were also provided for the period of December 2022 until June 2023 and demonstrated a number of visitors for each of the residents in care at the facility. Additional witness interviews and letters provided to the investigation establish in great detail visits being allowed to take place. As a result, the allegation is found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

Regarding the allegation that Staff are not ensuring that resident's dental hygiene needs are not being met, the following has been concluded: Resident interviews conducted corroborated oral care being provided. An additional witness interview W1 positively established that oral care was being provided to resident R1 in spite of the resident's inability to follow commands, especially regarding her mouth. Oral sponges are requested by facility staff to the hospice service and provided on a monthly basis, which was also confirmed by staff interviews conducted during the initial investigation. As a result, the allegation is found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

Regarding the allegation that Staff isolates resident, it was alleged that relatives and acquaintances of resident R1 were being actively prevented from visiting and/or contacting resident R1. An interview with the resident appeared to corroborate visits actually taking place. Records of the facility sign-in log were also provided for the period of December 2022 until June 2023 and demonstrated a number of visitors being able to visit with resident R1. Additional witness interviews and letters provided to the investigation establish in great detail visits, phone calls and video calls being allowed to take place, in spite of the presence of orders requesting to limit the duration of the calls in question for the health and welfare of resident R1. The fact that staff isolates R1 cannot be corroborated, therefore the allegation is found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided to facility administrator.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4