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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005946
Report Date: 03/25/2025
Date Signed: 03/25/2025 02:28:09 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
03/17/2025 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250317100336
FACILITY NAME:SERRA SOLFACILITY NUMBER:
306005946
ADMINISTRATOR:LINDSAY SCHROEDERFACILITY TYPE:
740
ADDRESS:31451 AVENIDA LOS CERRITOSTELEPHONE:
(949) 485-2022
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:70CENSUS: 55DATE:
03/25/2025
UNANNOUNCEDTIME BEGAN:
12:08 PM
MET WITH:Lindsay SchroederTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Facility staff are not reporting incidents as required
Staff are serving expired food to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Adminsitrator Lindsay Schroeder and explained the reason for the visit. The investigation into the allegation, facility staff are not reporting incidents as required revealed the following. It was alleged that the facility did not report an incident with Resident 1 (R1) in which they suffered an unknown injury causing bruising under each eye. LPA interviewed the Administrator and 5 staff members. R1 did suffer an unknown injury. Facility staff reported the incident to the Responsible Party and the Primary Care Physician. The injury was first noted on March 4, 2025, On March 5, 2025 the injury was noted to be around both eyes. R1's nurse practioner (NP) saw R1 on March 7, 2025. R1 was not sent to the hospital. Resident R1 could not be interviewed because they did not respond to the LPA's questions. R1 suffered an unknown injury that was not reported to the Agency. Facility staff verified this report. Based on the evidence gathered the preponderance standard has been met therefore the allegation is substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025
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
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
03/17/2025 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250317100336

FACILITY NAME:SERRA SOLFACILITY NUMBER:
306005946
ADMINISTRATOR:LINDSAY SCHROEDERFACILITY TYPE:
740
ADDRESS:31451 AVENIDA LOS CERRITOSTELEPHONE:
(949) 485-2022
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:70CENSUS: 55DATE:
03/25/2025
UNANNOUNCEDTIME BEGAN:
12:08 PM
MET WITH:Lindsay SchroederTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Staff did not ensure washing machine were working properly
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with the Adminsitrator Lindsay Schroeder and explained the reason for the visit. The investigaiton into the allegation revealed the following. LPA interviewed 6 staff members. All 6 staff members reported that 2 out of the 6 washing machines broke but were replaced immediately. All staff reported that there has always been working washing machines to do laundry. The washing machines are inaccessible to residents and the staff do all the laundry. LPA toured the facility and observed that all 6 washers and dryers are operational. Based on the evidence gathered the allegation is unsubstantiated, meaning 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 and a copy of the report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20250317100336
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: SERRA SOL
FACILITY NUMBER: 306005946
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/01/2025
Section Cited
CCR
87211(a)(1)(D)
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(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. (D)Any incident which threatens the welfare, safety or health of any resident,
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Licensee agrees to train staff on CCR 87211 reporting requirements and to submit proof of training to LPA>
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This requirement was not met as evidenced by, staff reported R1 had an unknown that was not reported to the Agency, this poses a potential health, safety and/or personal rights risks to residents in care.
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Type B
04/01/2025
Section Cited
CCR
87555(a)
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...All food shall be selected, stored, prepared and served in a safe and healthful manner.
This requirement is not being met as evidenced by;
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Licensee agrees to check all of stored food and to dispose of all expired food in the kitchen by the POC due date.
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LPA observed 12 cans of expired soup stored in the kitchen food storage area. This poses a potential health and safety risk to residents 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: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20250317100336
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: SERRA SOL
FACILITY NUMBER: 306005946
VISIT DATE: 03/25/2025
NARRATIVE
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The investigation into the allegation the facility serves expired food revealed the following. LPA toured the kitchen and inspected the food supply. LPA observed a two day perishable and a seven day non-perishable food supply on hand in the kitchen, LPA observed 12 cans of soup that expired on March 14, 2025. The kitchen staff disposed of the 12 cans of expired soup. LPA did not find any other expired food in the facility. LPA observed the kitchen is clean. Based on the evidence gathered the preponderance of evidence standard has been met therefore the allegation is substantiated. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4