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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005908
Report Date: 08/01/2023
Date Signed: 08/01/2023 12:16:12 PM

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
11/28/2022 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221128101937
FACILITY NAME:WESTMONT OF CYPRESSFACILITY NUMBER:
306005908
ADMINISTRATOR:PATRICK FRAZIERFACILITY TYPE:
740
ADDRESS:4889 & 4775 KATELLA AVE.TELEPHONE:
(858) 729-6720
CITY:LOS ALAMITOSSTATE: CAZIP CODE:
90720
CAPACITY:152CENSUS: 140DATE:
08/01/2023
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Executive Director Sheryl McCaskillTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility staff did not provide toilet paper to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to deliver findings on the complaint investigation. LPA met with and discussed the purpose of the visit with Executive Director Sheryl McCaskill.
The department investigated the above allegations and the investigation consisted of interviews, observations and documentation. It was alleged that facility staff did not provide toilet paper to residents. Based on interviews with staff and residents the investigation revealed that Residents in both Memory Care and Assisted Living received toilet paper as part of their house keeping services. Investigation also revealed that Residents that live in the independent living section are asked to provide their own toiletries if they are specifying for a certain type of toilet paper or soap that facility is not providing. During visit the resident restrooms observed all contained toilet paper.

CONTINUED on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
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 2
Control Number 22-AS-20221128101937
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: 08/01/2023
NARRATIVE
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Based on the evidence gathered the allegation facility staff did not provide toilet paper to residents is deemed UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with Executive Director and a copy of this report was provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2