306006344-8-21-2025-22-AS-APAO-DLEUHB-20250911153538

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006344
Report Date: 08/21/2025
Date Signed: 08/21/2025 10:46:16 AM

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
03/10/2025 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20250310123459

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: 69	DATE:	08/21/2025
		UNANNOUNCED	TIME BEGAN:	10:46 AM
MET WITH:	Cynthia Figueroa, Executive Director		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff did not properly maintain a resident's bathroom while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to deliver findings for a complaint investigation conducted by the Department. LPA was greeted and granted entry and met with Cynthia Figueroa, Executive Director (ED).

It was alleged that Staff did not properly maintain a resident's bathroom while in care due to Resident #1 (R1)’s toilet having traces of feces along the exterior of the toilet. Per photographs obtained dated December 26, 2024 & December 31, 2024, traces of feces appear to be observed along the outer edge of the toilet seat lid and rim. On January 01, 2025, photographs obtained show urine on the upper tank of R1’s toilet. Witness interviewed reported R1’s bathroom floor was sticky and appeared to have R1’s footprint on the tile.

Per R1’s admission agreement dated December 9, 2024 R1’s room is to be cleaned once a week. LPA interviewed two of two facility housekeepers who reported resident rooms are cleaned once a week, however, they will clean the rooms as needed if accidents occur and are reported to them. Interviews with
(Continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250310123459

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: 08/21/2025

NARRATIVE

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(Continued from LIC 9099)

housekeepers, care staff, and med techs report R1’s behaviors of urinating and having bowel movements were frequent.

Facility progress notes documented that on December 16, 2024 R1 had a bowel movement (BM) in the dining area and R1 spread BM on table and floor. It is charted that staff cleaned R1 and the cleaning area that was soiled. On December 17, 2024 R1 was assisted to the toilet and seated by staff but R1 stood up and wandered away while urinating on the floor. Staff interviews report accidents were not small and during one incident, it took the housekeeper over an hour to clean the area. R1’s behavior was also charted on December 21, December 30, January 4, January 5, 2025.

Staff stated accidents were always cleaned up but the frequency of R1’s behavior and the areas where incidents occurred, such as R1’s room, carpet, bathroom, and common areas, may have not been attended to. Staff stated they constantly redirected the resident to the toilet but R1 was combative with staff or refused to go. It is unclear when the feces and urine incidents occurred in R1's bathroom, and when staff would come to clean the area.

Although the 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 the allegation that Staff did not properly maintain a resident's bathroom while in care is Unsubstantiated. A Technical Violation will be given.

An exit interview was conducted with Cynthia Figueroa, Executive Director (ED) and a copy of the report, the LIC 9102-TV and files reviewed LIC 859 and LIC 811 were given at the time of the visit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025

LIC9099 (FAS) - (06/04)

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