306006344-7-16-2026-22-AS-AORZ-DWATP7-20260724145353

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006344
Report Date: 07/16/2026
Date Signed: 07/16/2026 12:09:56 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
06/15/2026 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20260615144722

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: 76	DATE:	07/16/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Susan Allen, Executive Director		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff interact inappropriately with resident
Staff do not provide adequate food service
Staff do not ensure facility is clean and sanitary
Staff do not ensure resident has clean bedding
Staff do not ensure resident's laundry is being done

INVESTIGATION FINDINGS:

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LIcensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to deliver findings for a complaint investigated by the Department. LPA was greeted and granted entry at 10am by the Business Office Director. LPA met with Executive Director (ED) Susan Allen and Assistant Executive Director (AED) Tamera Gant and explained the purpose of the visit.

LPA reviewed Resident #1 (R1)'s Physician's Report dated 8/20/2025, and R1's Plan of care, dated 8/11/2025 and Admissions Agreement, signed 8/14/2025, to review R1's services being provided by the facility. Over the course of the investigation LPA interviewed eight of eight staff members, eight of eight residents and one of one witness. The witness could not confirm, nor deny any of the allegations.

It was alleged that Staff interact inappropriately with resident. LPA interviewed eight of eight staff members regarding interactions with Resident #1 (R1). Eight of eight staff members stated that R1 is not excluded from activities, and that R1 is not separated from other residents in activities due to odor or other reasons.
(Continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

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-20260615144722

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: 07/16/2026

NARRATIVE

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(Continued from LIC 9099-C)

residents did not have clean bedding.

It was also alleged that Staff do not ensure resident's laundry is being done. Per Admissions Agreement and Resident Care Plan, Resident #1 (R1) is independent and does not receive personal laundering services and bed linens are laundered once per week. Eight of eight staff and seven of eight residents denied this allegation. Seven of eight residents stated they did not have any issues with laundry services.

Based on LPA's document review, observations and interviews the allegations that: Staff interact inappropriately with resident, Staff do not provide adequate food service, Staff do not ensure facility is clean and sanitary, Staff do not ensure resident has clean bedding and Staff do not ensure resident's laundry is being done are Unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Executive Director (ED) Susan Allen and a copy of this report and LIC 811 was provided at time of visit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20260615144722

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: 07/16/2026

NARRATIVE

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(Continued from LIC 9099)
Eight of eight staff stated Resident #1 (R1) chooses to sit away from other residents during activities, such as Bingo and that staff encourage R1 to participate in activities. One of eight staff stated that one day, after Bingo, that the staff member took the stairs which is adjacent to R1's apartment. Staff greeted R1 by their apartment door but did not prevent R1 from going to activities since the activity had just finished and merely was passing by the apartment. Eight of eight staff denied the allegation that they interact inappropriately with the resident. Seven of eight resident also denied the allegation that staff interact inappropriately.

LPA investigated the allegation that Staff do not provide adequate food service and asked if food service was delayed for R1 in the dining room. Eight of eight staff interviewed stated that R1 gets served timely and that the Dining Manager goes out of their way to assist with R1. Staff encourage R1 to have meals in the dining room. One of eight staff interviewed shared that, one evening, R1 ordered their meal after the rest of the table had put in their orders. Residents had already been seated at the table and ordered when R1 arrived and thus, the meal did not come out with the rest of the table. Seven of eight residents interviewed confirmed that R1 arrived later and they have not witnessed dining room staff delaying R1's meals. When the residents left the table early, due to completing their meal, R1 remained at the table to eat their meal. Eight of eight staff and seven of eight residents denied the allegation that Staff do not provide adequate food service.

LPA investigated the allegation that: Staff do not ensure facility is clean and sanitary. LPA toured the facility on June 19, 2026 and July 2, 2026 and did not detect any odors and the facility was clean and sanitary during all visits. Eight of eight staff interviewed and seven of eight residents stated the facility is clean and that if there is an issue, the staff will come immediately to repair or clean the area.

With regards to the allegation that resident did not have clean bedding, it was reported to LPA that there was one week when the assigned staff member to R1's apartment was out of the community. While the staff member was out, a second staff member asked if R1 needed bed linen service and R1 declined and stated they were fine. Per Admissions Agreement bed linen service is provided once a week. Currently there are two and a half housekeepers. The facility recently hired a part-time staff member; as requested by the residents at Resident Council. Eight of eight staff members and seven of eight residents denied residents did not have clean bedding. Eight of eight residents received notification that a staff member would be out for the week and an additional staff member would assist. Seven of eight residents denied the allegation that
(Continued on LIC 9099-C1)

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026

LIC9099 (FAS) - (06/04)

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