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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004761
Report Date: 05/08/2026
Date Signed: 05/08/2026 01:16:05 PM

Substantiated


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
05/01/2023 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230501113154
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: 84DATE:
05/08/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Office Assistant Teresa MejiaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff administered wrong medication dosage to resident
INVESTIGATION FINDINGS:
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On May 8, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to continue the investigation into the allegation listed above and to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Office Assitant Teresa Mejia was notified via telephone and later arrived to assist with the inspection.

During the course of the investigation, the Department interviewed staff, interviewed residents, reviewed and obtained pertinent documents to the complaint such as the current resident roster, current staff roster, and resident medication records. Regarding the allegation, staff administered wrong medication dosage to resident, the following has been concluded: It was alleged that staff administered the wrong medication dosage to Resident #1 (R1). The Department was unable to conduct an interview with R1 or review R1's medication, due to R1 moving out of the facility in December 2024. The Department conducted eight resident interviews. The facility currently manages the medication for seven out of the eight residents interviewed. CONTINUED ON LIC9099-C
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
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 5
Control Number 22-AS-20230501113154
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: 05/08/2026
NARRATIVE
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Two residents reported that they have had previous issues with their medication, such as not receiving their medication and not receiving the right amount of their medication. Five residents reported not having any issues with receiving their medication. The Department reviewed the medication and medication administration records for the seven residents. The Department observed that the facility did not have Resident #2's (R2's) Alendronate 70 MG tablet, despite R2 currently having active orders for the routine medication. The Department also observed the facility did not have Resident #3's (R3's) Amlodipine Besylate 10 MG tablet, despite R3 currently having active orders for the routine medication.

Based on the evidence gathered during this investigation, the Department obtained sufficient evidence to substantiate the allegations that, staff administered wrong medication dosage to resident. The preponderance of evidence standards has been met; therefore, the above allegation is SUBSTANTIATED. A deficiencies is being cited on the attached LIC9099-D page. An exit interview was conducted with Office Assistant Teresa Mejia. A copy of the report and appeal rights were provided at time of visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20230501113154
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2026
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care :(a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed.
This requirement was not evidenced by:
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The Executive Director stated that she will conduct an in service training with all staff regarding medication management and orders. The Executive Director agreed to provide LPA proof of training via email or fax by POC date.
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Based on records reviewed, the Licensee did not ensure that R2 and R3 had their routine medications present at the facility, despite having active orders for the medications. This poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/01/2023 and conducted by Evaluator Brandon Lopez
COMPLAINT CONTROL NUMBER: 22-AS-20230501113154

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: 84DATE:
05/08/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Resident Care Coordinator Teresa MejiaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Unqualified staff administering medication to residents
Staff shoved medication into resident's mouth
Facility has a rodent infestation
INVESTIGATION FINDINGS:
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On May 8, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to continue the investigation into the allegation listed above and to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Office Assistant Teresa Mejia was notified via telephone and later arrived to assist with the inspection.

During the course of the investigation, the Department interviewed staff, interviewed residents, reviewed and obtained pertinent documents to the complaint such as the current resident roster, current staff roster, staff training records, and pest control invoices. Regarding the allegation, unqualified staff administering medication to residents, the following has been concluded: The Department observed the facility has currently has five medication technicians and two wellness coordinators employed. The Department conducted six staff interviews. Six out of the six staff interviewed confirmed that only medication technicians and wellness coordinators are the only staff to assist with resident's medication. The Department conducted eight resident interviews. CONTINUE ON LIC9099-C
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
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 5
Control Number 22-AS-20230501113154
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: 05/08/2026
NARRATIVE
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The eight residents interviewed also confirmed that medication technicians and wellness coordinators are the only staff that have assisted them with their medication. The Department reviewed the training records for the five medication technicians and two wellness coordinators currently employed by the facility. The Department observed that the seven staff have received the initial, and annual medication training as required per regulations.

Regarding the allegation, staff shoved medication into resident's mouth, the following has been concluded: It was alleged that staff shoved medication into Resident #1 (R1) mouth. The Department was unable to conduct an interview with R1 for this complaint due to R1 moving out of the facility in December 2024. The Department conducted eight resident interviews. Eight out of the eight residents interviewed denied the allegation and reported that they have never been forced to take any medication. The Department conducted six staff interviews. Six out of the six staff interviewed also denied the allegation and denied ever observing a staff forcing a resident to take medication.

Regarding the allegation, facility has a rodent infestation, the following has been concluded: During the investigation, the Department inspected the facility's kitchen, dining area, laundry rooms, medication room, two staff offices, eight resident bedrooms, and the center courtyard area. During the Department's visits conducted to the facility on May 3, 2023, July 15, 2025, and May 8, 2026, the Department did not observe any rodents or any signs of rodents being present at the facility. The Department observed that the facility has consistently received pest control services twice a month to prevent any rodents. The Department observed the facility received pest control services on May 2, and May 16, 2023, which was the month the Department originally received the complaint. The Department additionally conducted eight resident interviews. Eight out of the right residents interviewed denied the allegation and denied ever observing a rodent present at the facility. The Department conduced six staff interviews. Six out of the six staff interviewed also denied the allegation and denied ever observing a rodent present at the facility.

Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the three allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with Office Assistant Teresa Mejia and a copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5