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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300600977
Report Date: 08/13/2025
Date Signed: 08/13/2025 03:04:47 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/05/2025 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20250805120829
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: 108DATE:
08/13/2025
UNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Christina Garcia and Sara ModugnoTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff does not ensure cleaning chemicals are made inaccessible to residents in care
Staff does not ensure medications are dispensed as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.

During the visit, LPA toured the memory care unit and interviewed staff as well as reviewed and obtained pertinent documentation such as medication administration records. Regarding the allegation that staff does not ensure cleaning chemicals are made inaccessible to residents in care and staff does not ensure medications are dispensed as prescribed, the investigation revealed the following: Memory care unit "Grace Gardens" has four kitchenettes in mini dining rooms for residents. LPA observed the door is unlocked in all four and all four had unsecured cleaning spray in an unsecured cupboard. One kitchenette had Windex and cleaning spray unsecured. LPA observed no staff in the kitchenettes but did observe a staff in the dining area. Grace Gardens serves residents with Dementia. Three out of three staff who administer medications state waiting for residents to swallow medications to ensure the medications are taken. CONTINUED ON LIC 9099C DATED 08/13/2025
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
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 5
Control Number 22-AS-20250805120829
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: TOWN & COUNTRY
FACILITY NUMBER: 300600977
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/14/2025
Section Cited
CCR
87309(a)
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Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions.. which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This req is not met as evidenced by:
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Licensee to discontinue storing cleaning supplies in kitchenettes and forward proof to LPA by POC due date.
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Based on observation, License failed to ensure cleaning supplies were secured. This poses an immediate health and safety risk to residents in care.
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Type A
08/14/2025
Section Cited
CCR
87464(f)(4)
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Basic services shall at a minimum include: Personal assistance and care as needed by the resident..., with those activities of daily living such as.. assistance with taking prescribed medications.. This requirement is not met as evidenced by:
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Facility to provide an in-service and forward proof to LPA by POC due date.
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Based on record review, Licensee failed to ensure residents were provided assistance with taking medication. Residents #1 and 2 missed multiple medications due to refills pending. This poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20250805120829
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: TOWN & COUNTRY
FACILITY NUMBER: 300600977
VISIT DATE: 08/13/2025
NARRATIVE
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Review of medication administration records show that two out of four residents reviewed are missing medication administration. Interview with Administrator indicates refills were pending however Residents 1 and 2 missed multiple periodic days of medications.


Based on record review and observation, the preponderance of evidence standard has been met. Therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided to facility administrator along with appeal rights.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/05/2025 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20250805120829

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: 108DATE:
08/13/2025
UNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Christina Garcia and Sara ModugnoTIME COMPLETED:
03:20 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff does not ensure adequate supervision is provided resulting in residents being left on the floor from falls
Staff do not ensure sharp objects are made inaccessible to residents in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the memory care unit and interviewed staff as well as reviewed and obtained pertinent documentation such as staffing schedule. Regarding the allegations that staff does not ensure adequate supervision is provided resulting in residents being left on the floor from falls and staff do not ensure sharp objects are made inaccessible to residents in care, the investigation revealed the following: LPA toured the memory care including four kitchenettes/ dining rooms and did not observe any sharp objects. LPA reviewed staff schedule which provides the following: 6-8 caregivers/ 2 med techs/ lead and an LVN on 1st and second shifts and 5 caregivers/ med tech or LVN on NOC shift. LPA observed ample staff during today's visit. Four out of four staff deny staffing issues as well as any residents being left on the floor for extended periods of time. Staff state checking residents every15 minutes and confirm there is enough staff to care for residents. CONTINUED ON LIC 9099C DATED 08/13/2025.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20250805120829
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: TOWN & COUNTRY
FACILITY NUMBER: 300600977
VISIT DATE: 08/13/2025
NARRATIVE
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Based on observations made and interviews conducted, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit interview was conducted and copy of the report was provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5