306004761-2-21-2025-22-AS-AORZ-DEVTEX-20250318144038

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004761
Report Date: 02/21/2025
Date Signed: 02/21/2025 11:34:01 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
12/24/2024 and conducted by Evaluator Michael Tea

COMPLAINT CONTROL NUMBER: 22-AS-20241224142052

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: 83	DATE:	02/21/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Lupe Jaime		TIME COMPLETED:	11:48 AM

ALLEGATION(S):

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- Staff did not ensure resident's wound care needs were met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Tea made an unannounced complaint visit on this day to conclude the investigation and to deliver findings for the allegation mentioned above. LPA met with Purchasing House Keeper Supervisor (PHKS) Lupe Jaime and spoke to Executive Director (ED) Lauren Chon over the phone.
It was alleged that staff did not ensure resident’s wound care needs were meet. During the investigation LPA interviewed Resident 1 (R1) and facility staff, checked, and reviewed resident files. The investigation determined the following:
Resident 1 (R1) is an independent resident. They are able to care for their personal needs, can administer and store their own medication and does not need constant medical supervision as indicated on their physician’s report. R1’s Individualized Service Plan indicates that staff monitors R1 for fall risk and any change of behavior. The Appraisal Needs and Services Plan shows R1 does not need any services. R1’s Resident Assessment form indicates they are independent and requires no assistance in all the ADLs assessed. Two out of two staff interviewed and Executive Director, Lauren Chon indicated that

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

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-20241224142052

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: 02/21/2025

NARRATIVE

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R1 was independent and refused assistance. All staff interviewed said they would help R1 when called or needed assistance. Per interview with R1, they indicated they were independent and did not need assistance only when asked. R1 said the facility staff helped them as best as they could.
Per records obtain, it was not until R1 went to the hospital in October for weakness and a urinary tract infection, that they discovered R1’s wound. The hospital provided outpatient care and home health services to care for the wound. All staff interviewed, and ED Chon indicated that after R1 came back from the hospital and said that home health services was responsible for taking care of R1’s wound. Two out of two staff interviewed indicated that they helped occasionally with cleaning and bandaging the wound when R1 asked for assistance when home health was not present. All staff interviewed said they check on her everyday and said that R1 never complained or said anything.
Based on records obtain, an internal incident report for December 23, 2024, a home health nurse asked Staff 1 (S1) to call 911 to send R1 out because their wound got infected. S1 also said that the home health nurse who asked them to call 911, explained a previous home health nurse did not properly care and bandaged the wound for R1 which resulted in the wound getting infected. When interviewed about home health care, R1 said that they were taking good care of them and had no problems with the services provided. Facility staff and the ED thought home health service was taking proper care of R1’s wound until 911 had to be called and the home health service did not indicated or communicated anything to the facility.
Therefore, based on LPA Tea's observations and interviews conducted and records review the allegation that staff did not ensure resident’s wound care needs were met has been determined to be unsubstantiated meaning 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.
No deficiencies cited at this time and an exit interview was conducted with Executive Director Chon over the phone and a copy of the report and confidential names list was provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC9099 (FAS) - (06/04)

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