<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004761
Report Date: 01/30/2024
Date Signed: 02/13/2024 09:05:20 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/06/2021 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210106170715
FACILITY NAME:CAMBRIDGE COURTFACILITY NUMBER:
306004761
ADMINISTRATOR:LAUREN CHONFACILITY TYPE:
740
ADDRESS:1621 COMMONWEALTH AVENUE, EASTTELEPHONE:
(714) 992-1750
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:99CENSUS: 76DATE:
01/30/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Edgar PalaciosTIME COMPLETED:
08:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Medications are not stored.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 This is an amended report

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation(s). LPA met with Staff #1 (S1) Edgar Palacios and explained the reason for today’s inspection. Administrator (AD) Lauren Chon appeared via telephone.

The investigation into the allegation that medications are not stored revealed the following: During the course of the investigation, LPA inspected the facility, interviewed the administrator and residents, and obtained and reviewed copies of the resident roster, staff roster, and resident files.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
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 7
Control Number 22-AS-20210106170715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CAMBRIDGE COURT
FACILITY NUMBER: 306004761
VISIT DATE: 01/30/2024
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
Regarding the allegation that medications are not stored: It was alleged that some residents are storing their own medications. LPA inspected the medication room and observed that the centrally stored medications were properly stored. LPA interviewed AD who stated that some residents handle their own medications if they are able to per their Physician’s Reports. LPA interviewed eight residents, three of whom stated they handle their own medications. LPA reviewed the Physician’s Reports for these three residents and the Physician’s Reports for two of the residents stated they are able to handle their own medications. However, the most recent Physician’s Report for one of the residents stated they are not able to handle their own medications and the facility still allowed them to store and handle their own medications. No information was obtained that this resulted in harm to the resident.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.

This is an amended report
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 22-AS-20210106170715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CAMBRIDGE COURT
FACILITY NUMBER: 306004761
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2024
Section Cited
CCR
87465(a)(4)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care (a) … (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated they create a list of all residents storing and handling their own medications, review the residents’ Physician’s Reports to ensure they are able to handle their own medications, and submit proof to LPA by POC due date.
8
9
10
11
12
13
14
Based on interviews and documents, the licensee did not provide required assistance with medications to one out of eight residents, which poses a potential health risk to persons in care.
8
9
10
11
12
13
14
Type B
02/27/2024
Section Cited
CCR
00000
1
2
3
4
5
6
7
This page was amended due to this second citation being created in error.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/06/2021 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210106170715

FACILITY NAME:CAMBRIDGE COURTFACILITY NUMBER:
306004761
ADMINISTRATOR:LAUREN CHONFACILITY TYPE:
740
ADDRESS:1621 COMMONWEALTH AVENUE, EASTTELEPHONE:
(714) 992-1750
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:99CENSUS: 76DATE:
01/30/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Edgar PalaciosTIME COMPLETED:
08:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff stole resident's money.
Staff not serving an adequate amount of food to resident's.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 This is an amended report
This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation(s). LPA met with Staff #1 (S1) Edgar Palacios and explained the reason for today’s inspection. Administrator (AD) Lauren Chon appeared via telephone. The investigation into the allegations that staff stole resident's money and staff not serving an adequate amount of food to residents revealed the following: During the course of the investigation, LPA inspected the facility, interviewed the administrator and residents, and obtained and reviewed copies of the resident roster, staff roster, resident files, menus, and dietician documents.
Regarding the allegation that staff stole resident's money: It was alleged that while a resident was in the hospital, staff went through the resident’s room and stole $160.00 in cash and that the facility did not take any steps to address the issue. LPA interviewed eight residents, one of whom claimed that they had $160.00 and a package stolen and believed these items were stolen by a staff member.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 22-AS-20210106170715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CAMBRIDGE COURT
FACILITY NUMBER: 306004761
VISIT DATE: 01/30/2024
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
 LPA attempted to interview a staff member who the resident claimed could confirm that the $160.00 and package were not present in the resident’s room, but LPA was unsuccessful. The resident did not claim that they, or anyone else, witnessed a staff member actually take the items. LPA interviewed AD who stated that the facility does receive complaints about missing money or items, but that the facility is unsure if they were lost or stolen and there have been incidents of these items later being found after it was originally thought that they were stolen. AD stated that when residents are in the hospital, their rooms are double-locked and only a few staff have the key to the second lock as a measure to protect resident property. AD also stated that after hearing of these incidents they had a meeting with staff about the issue. While one resident believes $160.00 and a package were stolen by staff, there is insufficient evidence to support this allegation as these items could have been misplaced, taken by a family member or another resident, or the resident may have otherwise disposed of them and forgotten. Regarding the allegation of staff not serving an adequate amount of food to residents: It was alleged that the food is substandard and residents are not able to eat much of the food served. LPA inspected the kitchen and observed no spoiled or expired foods, proper temperatures in the refrigerator and freezer, the kitchen, refrigerator, and freezer were clean and organized, and the perishable food appeared fresh and included fresh fruit and vegetables. LPA interviewed eight residents, five of whom provided positive reviews of the food. Three residents expressed concerns over the food, but one of these concerns was related to COVID-19 dining restrictions in the past that are no longer in effect and another concern had never been reported to the staff which did not allow the facility opportunity to address the issue. None of the residents reported an issue with the amount of food provided. AD stated that the facility is proud of the food it serves, emphasizes quality food even if it costs more, and uses a dietician to approve the menu and inspect the kitchen regularly. LPA reviewed the facility’s menus and noted a proper variety of foods including mostly hot dishes with a balance of meat and vegetables. LPA also reviewed documents provided by the facility’s dietician corroborating AD’s statement that a dietician is reviewing the facility’s menu and food practices. AD also stated that if there is an issue with the food, residents can communicate that to staff and the facility will address the issue. A resident interviewed corroborated that they are offered choices in their meals and that the facility is responsive to their preferences. The information received regarding this allegation is conflicting. Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative. This is an amended report
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/06/2021 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210106170715

FACILITY NAME:CAMBRIDGE COURTFACILITY NUMBER:
306004761
ADMINISTRATOR:LAUREN CHONFACILITY TYPE:
740
ADDRESS:1621 COMMONWEALTH AVENUE, EASTTELEPHONE:
(714) 992-1750
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:99CENSUS: 76DATE:
01/30/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Edgar PalaciosTIME COMPLETED:
08:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff accessed resident's personal belongings without permission.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation(s). LPA met with Staff #1 (S1) Edgar Palacios and explained the reason for today’s inspection. Administrator (AD) Lauren Chon appeared via telephone.

The investigation into the allegation that staff accessed resident's personal belongings without permission revealed the following: During the course of the investigation, LPA inspected the facility, interviewed the administrator and residents, and obtained and reviewed copies of the resident roster, staff roster, resident files, menus, and dietician documents.

Regarding the allegation that staff accessed resident's personal belongings without permission: It was alleged that while a resident was in the hospital, staff went through the resident’s room and rummaged through the resident’s personal paperwork and that the facility did not take any steps to address this issue.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 22-AS-20210106170715
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CAMBRIDGE COURT
FACILITY NUMBER: 306004761
VISIT DATE: 01/30/2024
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
LPA interviewed eight residents, none of whom corroborated that staff are accessing residents’ personal belongings without permission. No information was obtained corroborating this allegation.

The Department has investigated the above allegation and found it to be Unfounded, meaning the allegation was false, could not have happened, or is without reasonable basis. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7