306006253-5-26-2026-22-AS-AORZ-DUQQA2-20260604115914

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006253
Report Date: 05/26/2026
Date Signed: 05/26/2026 03:25:53 PM

Substantiated

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
05/20/2026 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20260520155155

FACILITY NAME:	SENIOR'S RETREAT OF BREA, INC., THE		FACILITY NUMBER:	306006253
ADMINISTRATOR:	SMITH, LORNA		FACILITY TYPE:	740
ADDRESS:	311 GUAVA PL		TELEPHONE:	(562) 746-7899
CITY:	BREA	STATE: CA	ZIP CODE:	92821
CAPACITY:	6	CENSUS: 2	DATE:	05/26/2026
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Lorna Smith, Administrator		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Licensee does not ensure visitor policy is posted in the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by Lorna Smith, Administrator (AD) and explained the purpose of the visit. Currently there are two residents in care. The facility has an approved fire clearance for six non-ambulatory with a hospice waiver for six.

LPA obtained the following documents for Resident #1 (R1): Identification and Emergency Information form, Preplacement Appraisal Information, Functional Capability Assessment, Appraisal Needs and Services Plan, Physician's Report dated 1/28/2026, Personal Rights, House Rules with stated visiting hours from 10am - 6pm, Admissions Agreement signed on 2/5/2026 which states visiting hours are from 10a-6p, Medication Administration Records (MARs) from Feburary through May 2026, Facility Progress Notes and Facility handwritten Incident Report. LPA also received a copy of the Power of Attorney (POA) documents via email. LPA also received a copy of the 30-day eviction notice for R1.
(Continued on LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026

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-20260520155155

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: SENIOR'S RETREAT OF BREA, INC., THE	FACILITY NUMBER: 306006253
	VISIT DATE: 05/26/2026

NARRATIVE

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(Continued from LIC 9099)

It was alleged that Licensee does not ensure visitor policy is posted in the facility. LPA toured the facility and observed visiting hours were not posted in the facility. LPA reviewed paperwork removed from the bulletin board during the week of May 18th, due to dry wall construction work being done on the wall. No visiting hours were posted. File review did show that visiting hours were stated in both the House Rules policy and Admissions Agreement signed on 2/5/2026.

LPA interviewed two of two residents who stated they are allowed visitors and can come and go as needed. Two of two residents had no issues with the visiting policy. LPA interviewed two of two staff who stated visiting hours were verbally shared with visitors. Staff stated they accommodate visitors, even if they go past visiting hours; where visitors have remained in the facility through 8pm or 9pm. Staff also stated they provide visiting hours for consistency for the residents and staff routines and request visitors abide by the rules.

Based on LPA's observations, file review and interviews, the allegation that: Licensee does not ensure visitor policy is posted in the facility is Substantiated. A Technical Violation will be given and visiting hours were posted by the end of the visit. An exit interview was conducted with Administrator, Lorna Smith, and a copy of this report, LIC 811 and LIC 9102-TV was provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026

LIC9099 (FAS) - (06/04)

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