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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300600977
Report Date: 07/02/2025
Date Signed: 07/02/2025 02:03:20 PM

Unfounded


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
12/09/2024 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20241209152259
FACILITY NAME:TOWN & COUNTRYFACILITY NUMBER:
300600977
ADMINISTRATOR:SARA MODUGNOFACILITY TYPE:
741
ADDRESS:555 E. MEMORY LANETELEPHONE:
(714) 547-7581
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:328CENSUS: 212DATE:
07/02/2025
UNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:SaraTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not assist resident with feeding, resulting in significant weight loss
Staff did not seek medical attention for resident in a timely manner
Staff did not administer resident's medications
Staff did not safeguard resident's personal belongings
INVESTIGATION FINDINGS:
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On July 2, 2025, Licensing Program Analyst (LPA) Sam Haddadin conducted an unannounced visit to this facility to deliver findings regarding the following allegations: staff did not assist the resident with feeding, resulting in significant weight loss; staff did not seek medical attention for the resident in a timely manner; staff did not administer the resident's medications; and staff did not safeguard the resident’s personal belongings.
During the investigation, LPA reviewed Resident 1’s (R1) facility file, including medical records, the admission agreement, inventory sheet, E mail records, staff roster , censuses and progress notes. LPA also interviewed staff members who were present during R1’s 32-day stay, as well as residents who lived at the facility before, during, and after that time.
Regarding the allegation that staff did not assist R1 with feeding and did not administer medications, progress notes show that on October 6, 2024, R1 initially refused food and medication. However, later that same day, R1 was offered a bowl of cereal and consumed 100 percent of it. On October 9, 2024, R1 again refused both food and medication,
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
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 2
Control Number 22-AS-20241209152259
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: TOWN & COUNTRY
FACILITY NUMBER: 300600977
VISIT DATE: 07/02/2025
NARRATIVE
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 but was offered liquids and snacks throughout the day. Staff notes document multiple attempts to encourage R1 to eat and take medication. Under Title 22, California Code of Regulations Section 87465(a)(5)(D), residents cannot be forced to take medications or eat, as doing so would violate their personal rights. Staff interviews consistently described R1 as verbally and physically aggressive and noted that R1 often refused care, including meals and medication.
Regarding the allegation that staff did not seek timely medical attention, facility records show that R1’s family designated Dr. Eric Khau as the primary physician. When R1 was diagnosed with a urinary tract infection, Dr. Khau prescribed oral antibiotics. Staff followed the physician’s instructions, although R1 continued to refuse medication. Documentation supports that medical attention was provided in a timely manner.
As for the allegation related to safeguarding personal belongings, Form LIC 821 “Personal Property and Valuables” did not reflect any listed inventory from the family at the time of admission. Family members later claimed that a jacket, watch, electric razor, and spoon were missing. In response, the facility offered a $2,500 refund, which was accepted by the family in an email dated December 13, 2024.
Based on the preponderance of evidence, including documentation and interviews, all allegations are determined to be unfounded. This means the allegations were false, could not have happened, and/or lacked a reasonable basis.
No deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to Executive Director Sara Modugno.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2