306006344-7-31-2025-22-AS-AORZ-DKRQU2-20250821122758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006344
Report Date: 07/31/2025
Date Signed: 07/31/2025 04:00:01 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
10/11/2024 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20241011144206

FACILITY NAME:	COGIR OF BREA		FACILITY NUMBER:	306006344
ADMINISTRATOR:	FAYE, SAMUEL		FACILITY TYPE:	740
ADDRESS:	700 MADISON WAY		TELEPHONE:	(714) 681-0105
CITY:	BREA	STATE: CA	ZIP CODE:	92821
CAPACITY:	110	CENSUS: 70	DATE:	07/31/2025
		UNANNOUNCED	TIME BEGAN:	02:46 PM
MET WITH:	Cynthia Figueroa, Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility fails to provide a safe environment for its residents
Facility staff is not following dietary orders
Alcohol is being served to residents with a dementia diagnosis
Facility staff does not safeguard the residents' personal information
Climate control is not operational
Facility is admitting residents requiring a higher level of care and supervision
Transportation services included in the admission agreement are not being provided to the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility regarding a complaint received in the Regional Office. LPA was greeted and granted entry by the concierge and met with Executive Director (ED) Cynthia Figueroa and explained the purpose of the visit.

LPA reviewed the following documents: Resident roster from October 2024, Personnel Report (LIC 500) dated October 15, 2024, and Kitchen Staff Schedule from 10/7-10/27/2024. LPA reviewed seven of seven resident files which include: Resident Dietary Orders/Food Preferences Form, Identification and Emergency Information, Physician's Report, and Admissions Agreement. Additional documents obtained and reviewed were: October 2024 Activities Calendar, October 2024 Transportation Calendar, and Bus Repair invoice.

The Department interviewed thirteen of thirteen staff members, which include the former Chef and the current Chef at the facility. LPA also interviewed four of four alert residents.
(Continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025

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 3

Control Number 22-AS-20241011144206

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: COGIR OF BREA	FACILITY NUMBER: 306006344
	VISIT DATE: 07/31/2025

NARRATIVE

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(Continued from LIC 9099)

The Department conducted a ten day visit on October 15, 2024 and observed approximately forty residents in the dining room for dinner. Due to staff shortages in Memory Care, Memory Care residents were brought to dinner in the dining room. Three of four resident interviews denied the allegation that:Facility fails to provide a safe environment for its residents. Thus is allegation is Unsubstantiated.

LPA obtained standing modified diets from the kitchen and spoke to the Chef about resident allergies and preferences. Chef shared the line staff know resident preferences and they are posted in the kitchen. During the time the complaint was received, Chef was not an employee but currently, modified diets are followed. Three of four residents interviewed stated they did not have issues with food at this time. Seven of seven resident Physician Reports and modified diets were reviewed and were being followed. None of the residents reported having allergies or becoming ill from food. Thus the allegation that: Facility staff is not following dietary orders is Unsubstantiated.

LPA reviewed seven of seven Physician's Reports (LIC 602A) and spoke with ED Figueroa regarding alcohol policy for Memory Care. Currently two residents are allowed alcohol per LIC 602A but the majority of residents in Memory Care get a non-alcoholic alternative during Happy Hours. Thus, the allegation that: Alcohol is being served to residents with a dementia diagnosis is Unsubstantiated.

Four of four residents were asked if the facility safeguards their personal information. Three of four residents felt personal health information was safeguarded. One of four residents felt staff spoke about other residents' health issues. Nine of nine staff denied that resident personal information was improperly shared with others. Based on resident and staff interviews, the allegation that Facility staff does not safeguard the residents' personal information is Unsubstantiated.

Upon touring the facility. LPAs visited resident rooms and took temperatures in common areas. The temperature ranged between 72.3 - 74.1 degrees Fahrenheit. Three of four residents did not have any issues with temperature in their apartments and one of four residents received a partial refund due to an AC unit in disrepair. Thus the allegation that: Climate control is not operational is Unsubstantiated.

(Continued on LIC 9099C1)

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20241011144206

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: COGIR OF BREA	FACILITY NUMBER: 306006344
	VISIT DATE: 07/31/2025

NARRATIVE

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(Continued fro LIC 9099C)

LPA reviewed resident files and spoke to former ED regarding residents being admitted that need a higher level of care. Former ED stated on May 12, 2025 that Title 22 Regulations are clear about what diagnoses can or cannot be accepted. Residents who have a change of condition, such as falls, are reassessed with a new Needs and Services Plan, an updated Physician's Report and a care plan meeting. The allegation that: Facility is admitting residents requiring a higher level of care and supervision is Unsubstantiated.

LPA spoke with nine of nine staff, the ED and Life Enrichment Director regarding transportation services. LPA reviewed the October 2024 Activities Calendar, the Concierge and Transportation Log and obtained a Bus Repair Invoice. The community bus' wheelchair lift was not operable and had been inspected and then repaired. Both the Life Enrichment Director and Assistant were designated drivers during this time and the Transportation log does show residents were taken to appointments in the month of October 2024. Thus the allegation that: Transportation services included in the admission agreement are not being provided to the residents is Unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore the allegations that: Facility fails to provide a safe environment for its residents, Facility staff is not following dietary orders, Alcohol is being served to residents with a dementia diagnosis, Facility staff does not safeguard the residents' personal information, Climate control is not operational, Facility is admitting residents requiring a higher level of care and supervision
and Transportation services included in the admission agreement are not being provided to the residents are Unsubstantiated.

An exit interview was conducted with Cynthia Figueroa, Executive Director and a copy of the report and files reviewed (LIC 811) were given at the time of the visit.

****This is an amended report.****

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025

LIC9099 (FAS) - (06/04)

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