306004761-3-24-2026-22-AS-APAO-DSY5H2-20260408195736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004761
Report Date: 03/24/2026
Date Signed: 03/24/2026 08:40:36 AM

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
10/31/2024 and conducted by Evaluator Cassandra Mikkelson

COMPLAINT CONTROL NUMBER: 22-AS-20241031084119

FACILITY NAME:	CAMBRIDGE COURT		FACILITY NUMBER:	306004761
ADMINISTRATOR:	LAUREN CHON		FACILITY TYPE:	740
ADDRESS:	1621 COMMONWEALTH AVENUE, EAST		TELEPHONE:	(714) 992-1750
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92831
CAPACITY:	99	CENSUS:	DATE:	03/24/2026
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Lauren Chon		TIME COMPLETED:	08:45 AM

ALLEGATION(S):

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Facility staff did not ensure the resident's medication is being administered as prescribed.
Facility staff mismanaged the resident's medication.
Facility did not provide the medication log to the responsible party as requested.
Facility did not inform the representative of the missing medication.

INVESTIGATION FINDINGS:

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On 03/24/2026, Licensing Program Analyst (LPA) Cassandra Mikkelson contacted the licensee via phone and email to deliver final findings regarding a complaint that was received on 10/31/2024.

The department conducted interviews and reviewed records relating to allegations of this complaint.

**Report continued on 9099-C page

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

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

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20241031084119

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: CAMBRIDGE COURT	FACILITY NUMBER: 306004761
	VISIT DATE: 03/24/2026

NARRATIVE

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Facility staff did not ensure the resident's medication is being administered as prescribed And Facility staff mismanaged the resident's medication

The department conducted a records review of resident's Medication Administrator Record (MAR) which showed that the facility administered the medication as prescribed. Therefore, the allegations facility staff did not ensure the resident's medication is being administered as prescribed and the allegation facility staff mismanaged the resident's medication is unsubstantiated.

Facility did not provide the medication log to the responsible party as requested

LPA reviewed messages sent between Resident #1(R1s) responsible party and facility Executive Director (ED). Per text messages on 10/25/2024, R1s responsible party received the medication log from the facility for R1. Therefore, the allegation facility did not provide the medication log to the responsible party as requested is unsubstantiated.

Facility did not inform the representative of the missing medication

The department conducted a review of Resident #1 (R1s) most recent Medication Orders from the Skilled Nursing Facility R1 previously resided at. The resident had four separate orders for the medication Vancomycin HCI Oral Capsule 125MG. One order was for 10 days with a start date of 10/08/2024. Another order was for seven (7) days and to be taken on Monday, Wednesdays and Saturday with a start date of 11/02/2024. The last two orders were for seven (7) days. One with a start date of 10/25/2024 and the other with a start date of 10/18/2024. The department cannot prove or disprove if the medications were started on those set dates and/or if the facility received those medications. Therefore, the allegation facility did not inform the representative of the missing medication is unsubstantiated.

Based upon the information obtained during investigation, the above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted a copy of the report and appeal rights were mailed to the facility .

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

LIC9099 (FAS) - (06/04)

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