306005908-11-14-2025-22-AS-APAO-DNN53R-20251121183622

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005908
Report Date: 11/14/2025
Date Signed: 11/14/2025 01:26:37 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
11/05/2025 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20251105230139

FACILITY NAME:	WESTMONT OF CYPRESS		FACILITY NUMBER:	306005908
ADMINISTRATOR:	NANCY RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	4889 & 4775 KATELLA AVE.		TELEPHONE:	(858) 729-6720
CITY:	LOS ALAMITOS	STATE: CA	ZIP CODE:	90720
CAPACITY:	152	CENSUS: 141	DATE:	11/14/2025
		UNANNOUNCED	TIME BEGAN:	07:09 AM
MET WITH:	Executive Director Nancy Rodriguez		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff do not ensure resident medications are given as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced inspection visit to initiate complaint investigation and deliver findings into the above allegations. LPA explained the reason for the visit with Executive Director Nancy Rodriguez.
During the course of the investigation, LPA toured facility, reviewed resident records, and conducted staff interviews. During investigation LPA requested pertinent documentation such as Resident Medication Administration Record, Needs & service plan, Active medication list, and Discharge paperwork and orders.
Regarding the allegation Staff do not ensure resident medications are given as prescribed, during visit LPA reviewed Resident 1’s (R1) records and observed that on 9/25/25 R1 went out of facility to Rehabilitation center for physical therapy, recommended durable medical equipment, speech therapy, occupational therapy and pain management. Discharge Paperwork from Rehabilitation center dated 10/3/25 stated that R1 did not have prescriptions refilled and R1 was to follow up with Primary Care Physician.

CONTINUED ON 9099C

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025

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-20251105230139

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: WESTMONT OF CYPRESS	FACILITY NUMBER: 306005908
	VISIT DATE: 11/14/2025

NARRATIVE

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On R1’s Rehabilitation discharge paperwork, Medication Ibuprofen was not listed as an active medication. LPA reviewed R1’s Medication Administration Record (MAR) dated from September 1, 2025 to November 14, 2025 and observed that R1 had an active order for Ibuprofen 200mg from 8/21/25 to 10/4/25. Facility MAR confirms R1 was given medication 8/21/25 to 9/25/25. Facility MAR notes that R1 did not receive Ibuprofen medication from 9/26/25- 10/3/25 due to R1 being out of facility. On 10/3/25, R1’s Service plan was updated and resident was assessed upon return from Rehabilitation facility. R1’s Updated Service plan states that R1 is actively on Medication Management, on med passes 4x a day and requires assistance with medications. LPA reviewed a Physician’s Medication Discontinuation order for Ibuprofen 200mg to be discontinued on 10/4/25. R1’s MAR notes from 10/4/25 to 10/31/25 Ibuprofen was discontinued and not administered to R1.

Based on staff interviews, four of four staff stated that there has been no known medication errors regarding R1. Interviews with Four of four staff state that Medication Technicians, resident service director, resident service coordinator, memory care director and Caregiver staff that are medication trained are allowed to administer medications to residents. Staff interviews confirmed that discontinued orders need to be a physical hard copy from Physician or Nurse Practitioner and no verbal orders can be accepted.

Based on records reviewed and interviews conducted, this agency has investigated the complaint alleging Staff do not ensure resident medications are given as prescribed. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and / or is without reasonable basis.

An exit interview was conducted with Executive Director Nancy Rodriguez and a copy of this report was reviewed and provided at the time of this visit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025

LIC9099 (FAS) - (06/04)

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