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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006344
Report Date: 02/10/2025
Date Signed: 02/10/2025 02:05:09 PM

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
01/31/2025 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250131142108
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: 48DATE:
02/10/2025
UNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Kara Kneedy-Cayem , Executive Director TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility is not in good repair
Facility is understaffed
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 Executive Director Kara Kneedy-Cayem and explained the reason for the visit.

The Department received a complaint on 01/31/2025 and LPA Mendivil conducted the initial 10 day visit on 02/10/2025. LPA Mendivil obtained copies of pertinent documents such as staff schedule and service documentation. LPA also interviewed staff and residents. Regarding the allegations, facility is not in good repair and facility is understaffed, the investigation revealed the following:

It was alleged an elevator in the facility was not operational. Based on interviews with Executive Director Kara , it was reported that the facility has 2 elevators. The first elevator is located in the front of the building near the mail room and the second elevator is located in the back of the bulding. It was reported the second elevator was non operational.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
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 2
Control Number 22-AS-20250131142108
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: COGIR OF BREA
FACILITY NUMBER: 306006344
VISIT DATE: 02/10/2025
NARRATIVE
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It was reported by ED Kara that the elevator did work but made a noise that was concerning. ED reported the elevator was "down" for 2 weeks until a technician could check the elevator. ED stated on 2/7/2025 a technician came to the facility to fix the noise issue in the elevator. Per review of work order Schindler Elevator Corporation "lubed rails" and elevator was opened back up for use by 1:50pm on 2/7/2025.

Regarding the allegation facility is understaffed. Per review of caregivers/med-tech schedule there are 5 staff members in the AM shift which is 6am-2:15pm, 4 staff members in the PM shift which is 2pm-10:15 and 2 staff members during NOC shift which is 10pm to 6:30 am for Assisted Living. Per interviews with 4 out of 4 residents state they feel all their needs are met and they have enough staff.

Therefore based on the preponderance of evidence through records review and interviews the allegations that facility is not in good repair and facility is understaffed are determined to be UNSUBSTANTIATED, meaning 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.

An exit interview was conducted and a copy of the report provided.

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

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2