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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006344
Report Date: 08/06/2025
Date Signed: 08/06/2025 03:36:25 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
06/03/2024 and conducted by Evaluator RoseMarie Ruppert
COMPLAINT CONTROL NUMBER: 22-AS-20240603152039
FACILITY NAME:COGIR OF BREAFACILITY NUMBER:
306006344
ADMINISTRATOR:FAYE, SAMUELFACILITY TYPE:
740
ADDRESS:700 MADISON WAYTELEPHONE:
(714) 681-0105
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:110CENSUS: 70DATE:
08/06/2025
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Cynthia Figueroa, Executive DirectorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff handled resident in a rough manner
Staff are not providing adequate food service to residents
Staff inappropriately attended a resident council meeting
Staff are not providing activities for residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate and deliver findings from a complaint received in the Regional Office. LPA met with Executive Director (ED) Cynthia Figueroa and explained the purpose of the visit.

LPA obtained the following documents: Resident #1 (R1)'s: Identification and Emergency Form, Physician's Report, Appraisal and Needs and Services Plans. LPA also requested a resident roster and obtained the August 2025 Memory Care "Revere" Calendar.

LPA interviewed three of three residents regarding the allegations listed above and attempted to contact their respective responsible parties. The Department also interviewed six of six staff members. Based on record review, observations and interviews the Department has determined the following:

(Continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
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-20240603152039
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: 08/06/2025
NARRATIVE
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(Continued from LIC 9099)

For the allegation that: Staff handled resident in a rough manner, the Reporting Party (RP) was not able to recall who the staff member was who treated the resident in a rough manner. Three of three residents interviewed could not recall if they were mistreated and six of six staff denied this allegation.

For the allegation that: Staff are not providing adequate food service to residents, LPA toured the Memory Care unit and observed what residents were eating for lunch. LPA surveyed the ten residents eating lunch and all residents were fine with their meal. LPA observed three staff members providing meal and beverage service, the entrees were hot and the beverages were cold. Three of three residents and six of six staff denied this allegation.

On June 13, 2024 the Department interviewed former Executive Director (ED) Kara Kneedy-Cayem regarding the allegation that: Staff inappropriately attended a resident council meeting. ED Kneedy-Cayem stated she was invited to the meeting by the resident council and attended for ten minutes to read "Residents' Rights" and then excused herself from the meeting. Additional staff interviews corroborated this statement. Six of six staff denied this allegation.

For the allegation that: Staff are not providing activities for residents, LPA interviewed the Life Enrichment Director (LED) and Resident Lifestyle Assistant (RLA) regarding activities provided for Memory Care. The LED had been hired on June 1, 2024 and was providing activities as well as the assistant. There were three days where both activities personnel overlapped and on some of those days, the RLA would provide transportation to residents for appointments. On those days, the RLA would begin an activity and the care staff in Memory Care would try to complete the activity. Activities were always planned but due to staff shortages during that time, activity staff would have to pivot. Two of two Activities staff denied the allegation. LPA obtained the Activities Calendar for August 2025 and noted there are nine to ten activities scheduled daily in Memory Care.

Based on LPA observations, record review and interviews, although the allegations above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, there the allegations that: Staff handled resident in a rough manner, Staff are not providing adequate
(Continued on LIC 9099-C1)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20240603152039
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: 08/06/2025
NARRATIVE
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(Continued from LIC 9099-C)

food service to residents, Staff inappropriately attended a resident council meeting and Staff are not providing activities for residents are Unsubstantiated.

An exit interview was conducted with Cynthia Figueroa, Executive Director (ED) and a copy of this report and LIC 811 were provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3