306006344-3-20-2025-22-AS-AJLO-DFUN3C-20250418100606

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006344
Report Date: 03/20/2025
Date Signed: 03/20/2025 12:30:00 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
01/15/2025 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250115150043

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: 45	DATE:	03/20/2025
		UNANNOUNCED	TIME BEGAN:	07:30 AM
MET WITH:	Phil Altman		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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-Resident files do not have the required documentation
-Staff files do not have the required documentation
-Staff do not have criminal record clearance
-Staff do not have the required qualifications
-Staff do not respond to residents' calls for assistance in a timely manner
-Facility staff are not providing adequate food service

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegations. LPA arrive at facility was greeted and granted entry by receptionist. LPA spoke with Phil Altman, SVP of Operations and explained the purpose of the visit.

Findings are based upon this investigation which included resident file review, staff file review, tour of the physical plant of the facility and interviews conducted.

It is alleged resident files do not have the required documentation. LPA Martinez reviewed 10% of the resident census files. Files reviewed reflected that it was observed the records reviewed had all required documentation on file per title 22 requirements.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

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-20250115150043

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: 03/20/2025

NARRATIVE

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It is alleged staff files do not have the required documentation. Staff files are kept electronically and were made available to LPA. LPA reviewed 10% of hired staff at the facility and observed that all required documentation was in the files per title 22 requirements.

It is alleged staff do not have criminal record clearance. LPA obtained an employee roster for the facility. LPA reviewed staff files, and it was observed a Criminal Record Clearances was in staff files. LPA cross checked the roster to the Guardian background check system and observed all hired onboard staff were associated to the facility and cleared.

It is alleged staff do not have the required qualification. LPA reviewed 10% of the onboard hired staff files and observed that all required qualifications were met such as a medical assessment and training. It was observed that records reviewed reflected this paperwork and kept in the files per title 22 requirements.

It is alleged staff do not respond to residents’ calls for assistance in a timely manner. LPA conducted a facility visit on January 21, 2025, and toured the physical plant of the facility. Upon the tour LPA entered several resident apartments, common spaces, and restrooms and tested the pull cord system. LPA observed that facility utilizes a pull cord system as well as pendants. LPA observed that the response time for staff to respond to calls were between 2 minutes and 15 minutes throughout the various times call system was pulled. On today’s visit LPA toured the facility and observed residents being assisted by caregivers. Records review for call system for assistance logs reflect all alerts and reflect that the response time is anywhere between 50 seconds to average response time of 16 minutes 28 seconds.

It is alleged that facility staff are not providing adequate food service. LPA conducted a site visit on January 21, 2025, and on today’s visit. LPA toured the facility kitchen and bistro; it was observed that there was sufficient amount of quality and quantity of perishables and nonperishable food for residents. At the time of visits LPA observed food being prepped and staff preparing the food for resident meals. LPA obtained a copy of the facility weekly menu for review, and the always available menu and observed the food service to be well balanced with variety of choices. LPA conducted interviews with the facility Executive Chef and stated that food delivery is twice a week, and Saturdays as needed. Residents have the choice to modify the menu

Continued on LIC9099-C

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20250115150043

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: 03/20/2025

NARRATIVE

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to their liking as well as food being modified based on resident needs. Dining room services is from 7:00am to 7:00pm and after 7:00pm the bistro will be stocked with food and will be available to residents at all times of the day. Interview with facility residents 7 of 7 indicated that they didn’t have an issue with the food served and they have always been able to request food or request for something out of the menu and the bistro always has food for them. Tour of the dining room LPA observed food being served, menu posted, and always available menu posted.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted with facility representative and a copy of this LIC9099 report was left at facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC9099 (FAS) - (06/04)

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