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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006149
Report Date: 08/21/2026
Date Signed: 08/21/2026 11:38:54 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/06/2026 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20260706165624
FACILITY NAME:CARE CONNECTIONFACILITY NUMBER:
306006149
ADMINISTRATOR:GILBERT, ERICFACILITY TYPE:
740
ADDRESS:416 S JENNIFER LANETELEPHONE:
(714) 289-2273
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:6CENSUS: DATE:
08/21/2026
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Eric Gilbert - Licensee TIME COMPLETED:
11:50 AM
ALLEGATION(S):
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The facility is not assisting resident with medication
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit.
The Department received the complaint on July 7, 2026 and the initial 10 day visit on July 15, 2026. LPA Mendivil interviewed staff and resident as well as collected documents such as Medication Administrator Records for March - July 2026, medication list, and physician's orders for Resident 1 (R1). Regarding the allegation that facility is not assisting resident with medication the investigation revealed the following :

Resident 1 (R1) was admitted to the facility on September 30th, 2025 after a hospital stay. R1 has a diagnosis of dementia , afib, and chronic diastolic congestive heart failure based on Physician’s Report dated September 25, 2025. When R1 arrived at the facility in September 2025 their medication list included Amiodarone 200mg 1tab once daily. Amiodarone was also on a medication list dated October 10, 2025 for 200 mg 1tab once daily
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026
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 2
Control Number 22-AS-20260706165624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CARE CONNECTION
FACILITY NUMBER: 306006149
VISIT DATE: 08/21/2026
NARRATIVE
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R1 was enrolled with hospice in October 2025 with Grand Hospice which was discontinued shortly after enrollment. It was then reported R1 was enrolled Cinta Hospice in November, per medication list in November 2025 it listed amiodarone 200 mg 1 tab per day. On May 26, 2026 Cinta Hospice’s Dr advised R1's family and facility that R1 would be discharged from hospice effective on June 25, 2026. Per review of documents R1’s hospice was terminated on May 26, 2026 by R1’s responsible party which left R1 without a prescribing physician. On June 1, 2026 R1 was assigned to Mobile Care Medical Group and a physician assistant conducted an evaluation. During the evaluation R1’s medication list was reconciled by Mobile Care Medical Group on June 1, 2026, which lists Amiodarone 200mg 1 tab once daily. On June 18th, 2026, a prescription is dropped off with the label for Amiodarone 200mg ½ tab once daily. Facility nurse attempted to reconcile the medication as it did not match the prescription of 200mg 1 tab once daily. During this time the facility was then informed via email that the prescription for Amiodarone had been updated by R1’s cardiologist in November 2025 to Amiodarone 100mg once daily . It was reported by the facility that they did not receive the discharge paperwork or new prescription from R1 or R1’s responsible party in November 2025. The facility nurse was able to obtain the correct prescription from R1’s cardiologist on June 26, 2026 and R1 was given medications as prescribed.

LPA also reviewed Medication Administration records for the months of May, June and July and medications appeared to be given as prescribed. Facility Administrator Eric Gilbert and facility nurse both deny the allegation that the facility was not assisting R1 with their medications as they attempted to provide R1 with the correct dosage.

Therefore based on the preponderance of evidence through records reviewed and interviews the allegation that the facility is not assisting a resident with medication is determined to be UNSUBSTANTIATED, meaning although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred.

An exit interview was conducted and a copy of this report was provided along with LIC 811 - Confidential Names List.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2