306006344-6-18-2025-22-AS-APAO-DJ7T8Q-20250702143041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006344
Report Date: 06/18/2025
Date Signed: 06/18/2025 06:31:31 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
04/16/2025 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20250416144122

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: 54	DATE:	06/18/2025
		UNANNOUNCED	TIME BEGAN:	05:49 PM
MET WITH:	Cynthia Figueroa, Executive Director		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff are not following infectious protocols for residents
Staff are not meeting residents showering needs
Staff are falsifying residents LIC 602's
Staff are not providing a comfortable environment

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Hanna Gough and Rose Ruppert conducted an unannounced visit to deliver findings. LPAs met with Executive Director (ED), Cynthia Figueroa.

It was alleged staff are not following infectious protocols for residents due to resident 1 (R1) not being quarantined after being diagnosed with scabies. On April 14, 2025, R1 was seen by Physician due to R1 having an itchy rash. The After Visit Summary stated the following, “We did not see scabies mites when we scraped some of the skin flakes…however given scabies is fairly common and easy to treat we will go ahead and treat presumptively for scabies…” Interviews with ten of ten staff reported the facility follows infection control protocols and that R1 was placed in isolation and their clothing and linens were cleaned separate from other residents to avoid spreading. LPA interviewed two facility housekeepers who confirmed R1’s room was deep cleaned after R1 was cleared from isolation. On April 23, 2025 R1 was assessed by facility nurse after nine days of treatment and R1 did not have scabies.
(Continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025

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-20250416144122

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: 06/18/2025

NARRATIVE

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(Continued from LIC 9099)

It was alleged staff are not meeting residents showering needs due to resident 2 (R2) not receiving showers. LPA conducted interviews with ten of ten staff who reported R2 is independent in showering needs and does not require shower assistance. LPA interviewed four of four residents who did not report any concerns of body odors or smells from R2. LPA Hanna Gough interviewed R2 and stated to LPA that he does showers himself and nobody helps him. Per R2’s physician report dated June 10, 2023. R2’s needs and assessment dated March 20, 2025, R2 is independent in showering and does not require assistance. LPAs Ruppert and Gough spoke with ED Cynthia Figueroa and HWD regarding R2’s showering needs and will set-up a care plan meeting with family.

It was alleged staff are falsifying residents LIC 602's due to Executive Director changing residents LIC602’s when a resident complains or questions director in an effort to move residents to facility memory care. It was reported LIC602’s were changed for Residents #3, #4 and #5 (R3; R4; R5).

Per R3’s physician report dated February 24, 2025, R3 has a diagnosis of hepatic encephalopathy. The report was signed by MD Woo who was treating R3 for less than one month. Due to R3’s confusion, wandering and sundowning behavior at time of admission, R3 was re-evaluated on March 01, 2025, and was diagnosed with mild cognitive impairment and placed on hospice services. R3 moved into Assisted Living on February 28, 2025. On March 2 2025 R3 was transferred to Memory Care which was the appropriate placement.

Per physician report dated March 05, 2025, R4 has a diagnosis of dementia. Physician report was completed by R4’s primary care physician who treated R4 for the past five years prior to moving into the facility. A new Physician’s Report for R4, dated May 12, 2025, was conducted and an assessment is being obtained Family communicated with ED Figueroa to have R4 to transfer to Assisted Living but R4 currently resides in Memory Care.

Resident #5 recently passed away and was never a candidate to move into Memory Care. LPA interviewed R5’s Power of Attorney (POA) who stated R5 was residing in facility assisted living unit and had no intentions to move resident to memory care unit. Per POA, there were no concerns of R5’s LIC602 being re-evaluated and/or changed improperly. LPA interviewed ten of ten staff who denied the allegation.

(Continued on LIC 9099-C1)

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20250416144122

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: 06/18/2025

NARRATIVE

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(Continued from LIC 90990-C)

It was alleged Staff are not providing a comfortable environment due to being told not to speak to Community Care Licensing and hide information. LPA interviewed seven of seven staff who denied the allegation. LPA interviewed five of five residents who denied ever being told to not speak to licensing or hide information. LPA reviewed ten of ten staff member training records and observed mandatory reporter training is current and up to date. LPA observed required PUB475 posted in a prominent place notifying residents of the right to report concerns to Community Care Licensing.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations that: Staff are not following infectious protocols for residents, Staff are not meeting residents showering needs, Staff are falsifying residents LIC 602's and Staff are not providing a comfortable environment are Unsubstantiated.

An exit interview was conducted with ED Figueroa and a copy of this report and LIC 811 Confidential Names were provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025

LIC9099 (FAS) - (06/04)

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