A Mother Theresa Care

Allegation investigated: Resident used illegal drugs resulting in hospitalization

An unannounced complaint investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegation mentioned above. LPA met with Staff Maruja Camilon and discussed the purpose of the inspection. Complaint alleges Resident 1 (R1) used illegal drugs resulting in hospitalization. During the course of the investigation interviews were conducted with Resident 1 (R1), three facility staff, and five witnesses. During interview, R1 was unable to recall incident requiring hospitalization and was unable to confirm or deny allegation. During interview, Staff 1 (S1) stated R1 requires care and supervision at all times, and due to their diagnoses, R1 had been prescribed several medications in the last four years, which include anti-psychotics. (Cont. LIC9099-C) Unsubstantiated Per S1, R1 does become depressed and will refuse to drink water or eat which will often result in R1 suffering from a Urinary Tract Infection (UTI), and lead to R1 being prescribed antibiotics. S1 stated that on the morning of November 12, 2025, they were tending to R1 and observed that R1 was lethargic and dazed, which S1 believed to be a result of a UTI. Due to their observations, S1 contacted 911 and an ambulance responded to transport R1 and R1 was kept at the hospital for observation. Per S1, On November 13, 2025, they were contacted by the hospital and informed R1 tested positive for Cocaine and Benzodiazepine usage and would be kept for observation. S1 stated that although R1 is prescribed Benzodiazepines, R1 has no access to Cocaine. Per S1, R1 is constantly supervised and R1’s room is only accessed by staff. S1 stated R1 has minimal contact with their family and last visited them in June 2025. During that visit, S1 transported R1 to their sister’s home and stayed with R1 for the duration of the visit. Per S1, R1’s family does not visit the facility and does not send items to the facility with R1 when R1 visits. During interview, Staff 2 (S2) stated they were informed by S1 that R1 had been transported to the hospital for complications of a UTI on the afternoon of November 12, 2025. Per S2, on November 13, 2025, S1 informed them R1 tested positive for Cocaine and Benzodiazepines. S2 stated they did not know how R1 was exposed to Cocaine, being that none of the residents in care have access to narcotics. Per S2, R1 is prescribed Benzodiazepines as part of their routine medications. Per record review of R1’s Centrally Stored Medication and Destruction Record (CSMDR) dated October 1, 2025, R1 was prescribed 13 medications prior to their hospitalization and CSMDR dated December 1, 2025 indicated R1 was prescribed the same 13 medications after their hospitalization. During interview, Staff 3 (S3) stated they do not work directly with R1 and only assist with driving R1 to appointments and activities. Per S3, during their shift on November 12, 2025, S1 was concerned due to R1 appearing drowsy and confused. S3 stated S1 believed R1 had a UTI and thought these symptoms were related to the infection. Per S3, it was not until R1 went to the hospital that they heard from S1 that R1 tested positive for Cocaine. S3 stated all residents are closely monitored, especially R1, due to not being able to care for themselves unassisted. Per S3, during their employment at the facility there have been no incidents related to drug use. S3 stated R1 does not have visitors at the facility, nor is R1 able to physically leave the facility without assistance. Per S3, when R1 does leave the facility, they are always under direct staff supervision. (Cont. LIC9099-C) Per record review of Medical Records from UCI Placentia-Linda Hospital, R1 was received by ambulance to the emergency department on November 12, 2025. R1 appeared to be able to move all extremities but was slow to respond to directions given. R1 was admitted to the hospital for monitoring and hydration. During R1’s hospitalization, a urinalysis was performed which tested positive for a UTI, as well as Cocaine and Benzodiazepines. During interview, UCI Placentia-Linda Doctor, Witness 1 (W1) stated they were the doctor on duty in the emergency department when R1 was received via ambulance on November 12, 2025. Upon R1’s arrival, R1 was alert but seemingly lethargic and slow to answer questions with delayed bodily movements, which prompted W1 to order a drug panel via urinalysis. Per W1, in studying R1’s medical history they learned R1 suffered from a Traumatic Braint Injury (TBI) and had a history of mental health crisis and was prescribed several anti-psychotic and anti-seizure medications. Per W1, they then spoke with S1 and explained the results of the drug screening, as well as R1’s status pertaining to the UTI. W1 stated that although they personally order the drug screens, they do not have the expertise to determine which medications counteract to determine a false-positive result. Per W1, in their training and experience they have observed some medications to be misidentified in a drug screening but stated they could not attest as to what exact medications could result in a false reading in R1’s case. Per W1, they examined R1’s overall well being and current living conditions as being low risk for drug exposure, therefore opted for R1 to return to the facility after overnight treatment in the hospital. During interview, RX Plus Pharmacy Pharmacist, Witness 2 (W2) was presented with a list of R1’s medications dispensed by the pharmacy for the purpose of identifying if medications could result in a false positive for Cocaine in a drug panel. Per W2, it is not likely that a false positive reading would result for Cocaine, due to the test being designed to look for a specific metabolite, however, could possibly result in a false positive for opioids. W2 stated they recommended that if a reading returned positive, that a second confirmatory drug panel be given. Per W2, the drug panel detected Benzodiazepine due to R1 being prescribed Lorazepam, which is the drug name for Benzodiazepine. During Interview, Rx Pharmacy Plus Lab Technician, Witness 3 (W3) stated that in reference to false positive reading for Benzodiazepines, several medications prescribed to R1 could return a false positive in a drug panel. Per W3, in reference to a false positive reading for Cocaine, there was not a specific medication R1 is prescribed which would give a false positive reading, however, if R1 was taking any over-the-counter decongestants, a false positive could result for Cocaine. Additionally, W3 stated that due to the high number of medications R1 is prescribed the risk of a false positive reading for any narcotic is greatly increased. (Cont. LIC9099-C) During interview, R1’s Psychiatrist, Witness 4 (W4) stated they have been R1’s psychiatrist since December 18, 2023 to manage R1’s depression and Bipolar I. Per W4, they see R1 both in person and online once a month, or more often, if further care is needed. W4 stated R1’s last visit was on February 18, 2026 and was an in-person visit. Per W4, they have prescribed anti-depressants to help R1 manage their depression, which R1 has been off and on since 2023. W4 stated that during R1’s October 2025 appointment, they noticed R1 was withdrawn, was non-responsive to questions, and was unable to verbalize their care and as a result re-prescribed anti-depressants for R1. Per W4, at R1’s November 2025 appointment, they began to see a slight improvement in R1’s demeanor, but by R1’s January 2026 appointment, R1 was again displaying signs of mental decline. W4 stated as of their February 18, 2026 appointment, they are still actively altering R1’s medications to support their change in condition. Per W4, R1 has never been reported to use drugs or alcohol as a coping mechanism by facility staff, nor is the use of either substance allowed in the facility. W4 stated that when they alter R1’s prescriptions, they take note of the other medications R1 is being prescribed by other providers. Per W4, they did note that R1 has been recently prescribed antibiotics due to chronic UTIs and stated that although not common, antibiotics and NSAIDs such as Advil, Aleve, and Ibuprofen have been known to present a false reading for Cocaine on a drug screening. During interview, Nurse Practitioner, Witness 5 (W5) stated they have been R1’s care provider since approximately September 2025. Per W5, while they have been overseeing R1’s care, R1 has primarily been treated for UTI and stated there have been no other concerns regarding R1’s health, nor have any concerns been raised regarding R1’s medications. Per W5, R1 has never had a history of drug use, nor had a positive drug test. W5 stated due to R1’s cognitive impairment, they do not believe R1 has the mental capacity to access or use drugs and described R1 as having an almost comatose baseline and unable to care for themselves without supervision. Based on R1’s diagnoses, they require constant care and supervision and do not have access to use illegal narcotics. R1 is also prescribed 13 different medications, including Benzodiazepines and antibiotics, which could produce a false positive in a drug screening. Based on gathered information, the Department did not find sufficient evidence to support the allegation, “Resident used illegal drugs resulting in hospitalization.” Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is Unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Jul 29, 2026 · control 22-AS-20251113150334

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Maruja Camilon and the purpose of the inspection was discussed. Administrator (AD) Wesley Pao arrived at approximately 10:15 a.m. During the inspection, LPA and Staff Camilon conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with five resident bedrooms, one staff bedroom, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area. LPA observed residents resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew and faucets and toilets were operational. Water temperature tested at 110.1 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated November 20, 2025. Electric stove, microwave, laundry washer and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored and locked. LPA reviewed five of five resident files and three staff files. LPA interviewed three residents and two staff. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and was left at the facility.the state’s words, verbatim · CDSS document, Feb 19, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Maruja Camilon. Administrator (AD) Wesley Pao arrived at approximately 1:00 p.m. and the purpose of the inspection was discussed. During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with five resident bedrooms, one staff bedroom, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area. LPA observed three residents present, resting in their respective bedrooms. Per Staff Camilon, two additional residents were on a community outing. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 115.8-118.0 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service tag dated August 22, 2024. Electric stove, microwave, washer, and dryer were all inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored in a locked cabinet. LPA reviewed five resident files and three staff files. Two of five resident medical assessments did not include results of examination for TB; a Deficiency was cited on today’s date. LPA interviewed two residents and two staff. Based on the observations made during today’s inspection, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Feb 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Arnel Lorica. LPA met with Staff Maruja Camilon and explained the purpose of the inspection. Administrator (AD) Wesley Pao was contacted by phone and arrived at approximately 11:55 a.m. During the inspection LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with five resident bedrooms, one staff bedroom, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area. LPA observed residents watching television in the living room and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 124.5-126.6 F degrees; a Deficiency was cited on today’s date. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Food menu was also posted and visible. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Electric stove, microwave, washer, and dryer were all inspected and observed to be operable. Sharps were observed locked in a kitchen drawer. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents. Medication cabinet was observed to be locked. LPA reviewed six resident files and three staff files. Four out of six resident files did not have an appraisal dated in the last twelve months; a Deficiency was cited on today’s date. Staff files did not contain any documentation for initial 6 hours of hands-on required medication training. AD stated training was conducted upon hire but was not originally documented. One out of three staff files did not contain the 20 hours of annual staff training required; two additional Deficiencies were cited on today’s date. LPA interviewed three residents and two staff. (Cont. LIC809-C) Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Apr 24, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff did not accept resident back to the facility in a timely manner

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and met with Caregiver Maruja Camilon. LPA explained the reason for the visit. Administrator (AD) Wesley Pao arrived shortly after. On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: During the investigation LPA reviewed documents including the Unusual Incident/Injury Report (UIIR) dated 12/28/23 for Resident 1 (R1). Per UIIR on 12/26/23 at 9:00 PM Staff 1 (S1) called 911 and around 10:00 PM R1 was transported to Placentia-Linda Hospital. Records reviewed by LPA Ramirez included the Placentia-Linda Hospital Discharge Orders dated 12/28/23 for R1. Per Discharge Orders R1 was admitted to the Hospital on 12/27/23 and was discharged on 12/28/23. CONTINUED ON LIC9099-C... Unsubstantiated During interviews conducted with the residents, R1 reported that she was accepted back at the facility in a timely manner and that she was at the Hospital for less than two days. During interviews conducted with staff, Staff 1 (S1) reported that staff never said that they could not take the resident back. During the course of the interviews AD stated that it was a misunderstanding between the facility staff and the Hospital. Per AD R1 returned to the facility as soon as the Hospital was able to find transportation for R1. Based on LPA's observation and information gathered during the investigation, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed UNSUBSTANTIATED. LPA Ramirez conducted an exit interview with AD Pao , and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jan 8, 2024 · control 22-AS-20231229142122