306006360-9-24-2026-22-AS-SSAS-DY9VEU-20260925162256

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006360
Report Date: 09/24/2026
Date Signed: 09/24/2026 10:20:57 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
06/03/2026 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260603152802

FACILITY NAME:	WATERMARK LAGUNA NIGUEL		FACILITY NUMBER:	306006360
ADMINISTRATOR:	JOHNNY ORTIZ		FACILITY TYPE:	740
ADDRESS:	27762 FORBES ROAD		TELEPHONE:	(949) 899-8175
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY:	135	CENSUS: 75	DATE:	09/24/2026
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Johnny Ortiz		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff did not ensure resident' medical needs were being met resulting in resident developing an infection
Staff did not seek medical attention to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegations listed above. LPA met with Executive Director Johnny Ortiz and explained the reason for the visit.

The investigation into the allegation, staff did not ensure resident's medical needs were being met resulting in resident developing an infection, revealed the following. It was reported that after Resident 1 (R1) cut their leg and returned to the facility staff did not provide proper care and R1 developed an infection. R1 suffered an injury to their leg on February 21, 2026. Staff 1 (S1) reported that the injury was discovered around 5:50 am and the resident reported that it happened earlier in the morning and they didn’t press their pendant for assistance. S1 called 911 and resident was transported to the hospital. Facility staff notified R1’s responsible party and their physician. R1 came back to the facility the same day with 12 stitches (staples) to close the injury to their leg.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026

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 4

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
06/03/2026 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260603152802

FACILITY NAME:	WATERMARK LAGUNA NIGUEL		FACILITY NUMBER:	306006360
ADMINISTRATOR:	JOHNNY ORTIZ		FACILITY TYPE:	740
ADDRESS:	27762 FORBES ROAD		TELEPHONE:	(949) 899-8175
CITY:	LAGUNA NIGUEL	STATE:CA	ZIP CODE:	92677
CAPACITY:	135	CENSUS: 75	DATE:	09/24/2026
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Johnny Ortiz		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff did not issue a refund to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegation listed above. LPA met with Executive Director Johnny Ortiz and explained the reason for the visit.

The investigation into the allegation, staff did not issue a refund to resident, revealed the following. It was reported that the facility did not issue a refund after Resident 1 (R1) moved out of the facility. It was reported that R1’s responsible party should have received a refund of $3000.00 after R1 moved out. R1 moved into the facility on December 30, 2025, and moved out on February 28, 2026. A review of facility records shows R1’s responsible party was issued a refund in the amount of $3220.22 on or around June 30, 2026. The Administrator reported that after R1 moved out, R1’s responsible party was told they would be issued a refund, and it would take time so please be patient. The Administrator reported that refunds are handled through the corporate office and he has no control over them. LPA reached out to R1’s responsible party but never received a response.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026

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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 22-AS-20260603152802

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: WATERMARK LAGUNA NIGUEL	FACILITY NUMBER: 306006360
	VISIT DATE: 09/24/2026

NARRATIVE

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R1 where abouts are unknown so they couldn't be reached for an interview. R1’s statement of account ledger shows R1’s responsible party was issued a refund. The evidence gathered refutes the allegation therefore the allegation is deemed unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

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

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20260603152802

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: WATERMARK LAGUNA NIGUEL	FACILITY NUMBER: 306006360
	VISIT DATE: 09/24/2026

NARRATIVE

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The Administrator, S1 and Staff 2 (S2) reported that R1’s responsible party never provided the hospital discharge paperwork for R1. The Administrator reported they ordered a palliative care visit from a Hospice company to have R1 and their injury evaluated. R1’s responsible party did not respond to requests for an interview. A review of R1’s records does not show R1 was ever diagnosed with an infection. R1’s care visit shows only one visit was completed on February 23, 2026, and no issues were noted. R1 was moved out of the facility on February 28, 2026. R1’s location is unknown, so they were not interviewed. R1 was injured and as soon as the facility discovered the injury 911 was called and R1 was taken to the hospital and treated. Upon R1’s return, facility staff scheduled a follow-up visit with a medical provider. R1’s records do not show any mention of an infection. Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, staff did not seek medical attention to resident, revealed the following. It was reported that after R1 was injured staff did not get R1 medical attention. R1 suffered an injury on February 21, 2026. According to the special incident report (SIR) submitted by the facility to the Agency (Community Care Licensing) on February 25, 2026, R1 was discovered by staff at 5:50 am with a cut on their leg. Staff called 911 and R1 was transported to the hospital and treated. Staff notified R1’s responsible party and their physician. It was reported that staff did not seek medical treatment for R1. S1 and S2 who were present when R1’s injury was discovered reported that R1’s injury was discovered during a routine check at 5:50 am. S1 reported that R1 told them they had injured themselves earlier but did not report the accident. S1 and S2 stated that they called 911 as soon as possible after seeing the injury. R1’s where abouts are unknown so they could not be interviewed. R1’s responsible party did not respond to requests for an interview. The Administrator, S1 and S2, reported that R1’s responsible party did not provide the hospital discharge paperwork for R1 and R1's responsible party brought R1 back to the facility after their hospital visit. Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

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

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026

LIC9099 (FAS) - (06/04)

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