306006253-5-26-2026-22-AS-AORZ-DUQQA3-20260604115916

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006253
Report Date: 05/26/2026
Date Signed: 05/26/2026 03:33:44 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
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:	08:00 AM
MET WITH:	Lorna Smith, Administrator (AD)		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Licensee does not ensure required posted signs are placed prominently in the facility
Staff does not ensure medications are dispensed as prescribed

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.

Resident #1 (R1) moved into the facility on February 5, 2026 with a diagnosis of hemiplegia and hemiparesis per medical assessment on January 28, 2026. R1 is non-ambulatory and has mild forgetfulness. LPA interviewed two of two residents. Two of two residents stated they are being provided care by the staff and that they do not have any issues at this time.

It was alleged that Licensee does not ensure required posted signs are placed prominently in the facility.

(Continued on LIC 9099-C)

Unsubstantiated

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)
LPA observed the poster for the Long Term Care Ombudsman (LTCO) with ombudsman's contact information. Currently contractors are working on the dry wall for an extended patio; thus the posters were taken down from the bulletin board for contractors to do work. The posters were taken off the bulletin wall during the week of May 18, 2026.

LPA interviewed two of two residents who stated they have no issues with their care and were not aware of the posters on the wall. Two of two staff members confirmed the posters were on the bulletin board prior to contract work of the dry wall. One witness confirmed the posters were posted, a second witness could not confirm nor deny that the posters were posted. Thus, the allegation that Licensee does not ensure required posted signs are placed prominently in the facility is Unsubstantiated.

It was alleged that Staff does not ensure medications are dispensed as prescribed. LPA reviewed two of two resident Medication Administration Records (MARs) and made copies of Resident #1 (R1)'s MAR, Identification and Emergency Information Form, Physician's Report dated January 28, 2026. R1 takes three routine medications but one of the medications has not been refilled per a family member's request. The facility and Power of Attorney (POA) have requested the prescription for the behavior medication to be refilled. The next doctor's appointment for R1 is scheduled on June 5, 2026. None of the medications on the MAR cause drowsiness.

LPA interviewed two of two staff members regarding a resident being over medicated and two of two staff members denied the allegation and were not aware of which resident had this incident. Two of two witnesses interviewed also denied this allegation. LPA interviewed two of two residents and both stated they are happy with the care being provided and that they did not have any issues with medications.

Based on LPA's observations, record review and interviews, the allegations that: Staff does not ensure required posted signs are placed prominently in the facility and Staff does not ensure medications are dispensed as prescribed are Unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted with Administrator, Lorna Smith, and a copy of this report and LIC 811 were 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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