306005932-7-29-2026-22-AS-LMOA-DWJ88A-20260731221712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005932
Report Date: 07/29/2026
Date Signed: 07/29/2026 03:59:28 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
11/13/2025 and conducted by Evaluator Claudia Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20251113150334

FACILITY NAME:	A MOTHER THERESA CARE		FACILITY NUMBER:	306005932
ADMINISTRATOR:	PAO, WESLEY		FACILITY TYPE:	740
ADDRESS:	16192 CAIRO CIRCLE		TELEPHONE:	(714) 792-0967
CITY:	PLACENTIA	STATE: CA	ZIP CODE:	92870
CAPACITY:	6	CENSUS: 5	DATE:	07/29/2026
		UNANNOUNCED	TIME BEGAN:	03:21 PM
MET WITH:	Maruja Camilon		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Resident used illegal drugs resulting in hospitalization

INVESTIGATION FINDINGS:

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An unannounced complaint investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegation mentioned above. LPA met with Staff Maruja Camilon and discussed the purpose of the inspection.

Complaint alleges Resident 1 (R1) used illegal drugs resulting in hospitalization.

During the course of the investigation interviews were conducted with Resident 1 (R1), three facility staff, and five witnesses.

During interview, R1 was unable to recall incident requiring hospitalization and was unable to confirm or deny allegation. During interview, Staff 1 (S1) stated R1 requires care and supervision at all times, and due to their diagnoses, R1 had been prescribed several medications in the last four years, which include anti-psychotics. (Cont. LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026

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 4

Control Number 22-AS-20251113150334

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: A MOTHER THERESA CARE	FACILITY NUMBER: 306005932
	VISIT DATE: 07/29/2026

NARRATIVE

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During interview, R1’s Psychiatrist, Witness 4 (W4) stated they have been R1’s psychiatrist since December 18, 2023 to manage R1’s depression and Bipolar I. Per W4, they see R1 both in person and online once a month, or more often, if further care is needed. W4 stated R1’s last visit was on February 18, 2026 and was an in-person visit. Per W4, they have prescribed anti-depressants to help R1 manage their depression, which R1 has been off and on since 2023. W4 stated that during R1’s October 2025 appointment, they noticed R1 was withdrawn, was non-responsive to questions, and was unable to verbalize their care and as a result re-prescribed anti-depressants for R1. Per W4, at R1’s November 2025 appointment, they began to see a slight improvement in R1’s demeanor, but by R1’s January 2026 appointment, R1 was again displaying signs of mental decline. W4 stated as of their February 18, 2026 appointment, they are still actively altering R1’s medications to support their change in condition. Per W4, R1 has never been reported to use drugs or alcohol as a coping mechanism by facility staff, nor is the use of either substance allowed in the facility. W4 stated that when they alter R1’s prescriptions, they take note of the other medications R1 is being prescribed by other providers. Per W4, they did note that R1 has been recently prescribed antibiotics due to chronic UTIs and stated that although not common, antibiotics and NSAIDs such as Advil, Aleve, and Ibuprofen have been known to present a false reading for Cocaine on a drug screening.

During interview, Nurse Practitioner, Witness 5 (W5) stated they have been R1’s care provider since approximately September 2025. Per W5, while they have been overseeing R1’s care, R1 has primarily been treated for UTI and stated there have been no other concerns regarding R1’s health, nor have any concerns been raised regarding R1’s medications. Per W5, R1 has never had a history of drug use, nor had a positive drug test. W5 stated due to R1’s cognitive impairment, they do not believe R1 has the mental capacity to access or use drugs and described R1 as having an almost comatose baseline and unable to care for themselves without supervision.

Based on R1’s diagnoses, they require constant care and supervision and do not have access to use illegal narcotics. R1 is also prescribed 13 different medications, including Benzodiazepines and antibiotics, which could produce a false positive in a drug screening.

Based on gathered information, the Department did not find sufficient evidence to support the allegation, “Resident used illegal drugs resulting in hospitalization.” Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is Unsubstantiated.

An exit interview was conducted and copy of this report was provided at the end of the inspection.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20251113150334

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: A MOTHER THERESA CARE	FACILITY NUMBER: 306005932
	VISIT DATE: 07/29/2026

NARRATIVE

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Per record review of Medical Records from UCI Placentia-Linda Hospital, R1 was received by ambulance to the emergency department on November 12, 2025. R1 appeared to be able to move all extremities but was slow to respond to directions given. R1 was admitted to the hospital for monitoring and hydration. During R1’s hospitalization, a urinalysis was performed which tested positive for a UTI, as well as Cocaine and Benzodiazepines.

During interview, UCI Placentia-Linda Doctor, Witness 1 (W1) stated they were the doctor on duty in the emergency department when R1 was received via ambulance on November 12, 2025. Upon R1’s arrival, R1 was alert but seemingly lethargic and slow to answer questions with delayed bodily movements, which prompted W1 to order a drug panel via urinalysis. Per W1, in studying R1’s medical history they learned R1 suffered from a Traumatic Braint Injury (TBI) and had a history of mental health crisis and was prescribed several anti-psychotic and anti-seizure medications. Per W1, they then spoke with S1 and explained the results of the drug screening, as well as R1’s status pertaining to the UTI. W1 stated that although they personally order the drug screens, they do not have the expertise to determine which medications counteract to determine a false-positive result. Per W1, in their training and experience they have observed some medications to be misidentified in a drug screening but stated they could not attest as to what exact medications could result in a false reading in R1’s case. Per W1, they examined R1’s overall well being and current living conditions as being low risk for drug exposure, therefore opted for R1 to return to the facility after overnight treatment in the hospital.

During interview, RX Plus Pharmacy Pharmacist, Witness 2 (W2) was presented with a list of R1’s medications dispensed by the pharmacy for the purpose of identifying if medications could result in a false positive for Cocaine in a drug panel. Per W2, it is not likely that a false positive reading would result for Cocaine, due to the test being designed to look for a specific metabolite, however, could possibly result in a false positive for opioids. W2 stated they recommended that if a reading returned positive, that a second confirmatory drug panel be given. Per W2, the drug panel detected Benzodiazepine due to R1 being prescribed Lorazepam, which is the drug name for Benzodiazepine. During Interview, Rx Pharmacy Plus Lab Technician, Witness 3 (W3) stated that in reference to false positive reading for Benzodiazepines, several medications prescribed to R1 could return a false positive in a drug panel. Per W3, in reference to a false positive reading for Cocaine, there was not a specific medication R1 is prescribed which would give a false positive reading, however, if R1 was taking any over-the-counter decongestants, a false positive could result for Cocaine. Additionally, W3 stated that due to the high number of medications R1 is prescribed the risk of a false positive reading for any narcotic is greatly increased. (Cont. LIC9099-C)

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20251113150334

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: A MOTHER THERESA CARE	FACILITY NUMBER: 306005932
	VISIT DATE: 07/29/2026

NARRATIVE

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Per S1, R1 does become depressed and will refuse to drink water or eat which will often result in R1 suffering from a Urinary Tract Infection (UTI), and lead to R1 being prescribed antibiotics. S1 stated that on the morning of November 12, 2025, they were tending to R1 and observed that R1 was lethargic and dazed, which S1 believed to be a result of a UTI. Due to their observations, S1 contacted 911 and an ambulance responded to transport R1 and R1 was kept at the hospital for observation. Per S1, On November 13, 2025, they were contacted by the hospital and informed R1 tested positive for Cocaine and Benzodiazepine usage and would be kept for observation. S1 stated that although R1 is prescribed Benzodiazepines, R1 has no access to Cocaine. Per S1, R1 is constantly supervised and R1’s room is only accessed by staff. S1 stated R1 has minimal contact with their family and last visited them in June 2025. During that visit, S1 transported R1 to their sister’s home and stayed with R1 for the duration of the visit. Per S1, R1’s family does not visit the facility and does not send items to the facility with R1 when R1 visits.

During interview, Staff 2 (S2) stated they were informed by S1 that R1 had been transported to the hospital for complications of a UTI on the afternoon of November 12, 2025. Per S2, on November 13, 2025, S1 informed them R1 tested positive for Cocaine and Benzodiazepines. S2 stated they did not know how R1 was exposed to Cocaine, being that none of the residents in care have access to narcotics. Per S2, R1 is prescribed Benzodiazepines as part of their routine medications.

Per record review of R1’s Centrally Stored Medication and Destruction Record (CSMDR) dated October 1, 2025, R1 was prescribed 13 medications prior to their hospitalization and CSMDR dated December 1, 2025 indicated R1 was prescribed the same 13 medications after their hospitalization.

During interview, Staff 3 (S3) stated they do not work directly with R1 and only assist with driving R1 to appointments and activities. Per S3, during their shift on November 12, 2025, S1 was concerned due to R1 appearing drowsy and confused. S3 stated S1 believed R1 had a UTI and thought these symptoms were related to the infection. Per S3, it was not until R1 went to the hospital that they heard from S1 that R1 tested positive for Cocaine. S3 stated all residents are closely monitored, especially R1, due to not being able to care for themselves unassisted. Per S3, during their employment at the facility there have been no incidents related to drug use. S3 stated R1 does not have visitors at the facility, nor is R1 able to physically leave the facility without assistance. Per S3, when R1 does leave the facility, they are always under direct staff supervision. (Cont. LIC9099-C)

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026

LIC9099 (FAS) - (06/04)

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