306004399-1-12-2026-22-AS-APAO-DQCTBM-20260115133523

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004399
Report Date: 01/12/2026
Date Signed: 01/12/2026 02:10:19 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
01/06/2026 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260106153708

FACILITY NAME:	QUALITY SENIOR LIVING		FACILITY NUMBER:	306004399
ADMINISTRATOR:	MARIA DOLORES D TENTE		FACILITY TYPE:	740
ADDRESS:	24262 GRASS STREET		TELEPHONE:	(949) 215-3087
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	6	CENSUS: 3	DATE:	01/12/2026
		UNANNOUNCED	TIME BEGAN:	11:29 AM
MET WITH:	Maria Tente, administrator		TIME COMPLETED:	01:49 PM

ALLEGATION(S):

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Lack of care and supervision

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the allegation listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Multiple calls to administrator Maria Tente were made to notify her of the visit and present the allegation under review. Administrator was unable to be present and gave staff permission to sign the present report.

During the visit, LPA conducted a tour of the facility's physical plant. There are currently three residents in care. Resident records for all three residents were requested along with hospice records for resident R1. Resident and staff interviews were conducted or attempted during the visit. An additional witness interview with R1's responsible party and attorney-in-fact was also conducted during the investigation.

CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

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-20260106153708

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: QUALITY SENIOR LIVING	FACILITY NUMBER: 306004399
	VISIT DATE: 01/12/2026

NARRATIVE

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CONTINUED FROM FORM LIC9099
Regarding the allegation of Lack of care and supervision, the following has been concluded: Resident R1 was admitted at the facility on November 15, 2022 with a primary diagnosis of atherosclerotic vascular disease. At the time of admission, R1 was also admitted under hospice care. On January 2, 2026, R1 sustained a fall incident while receiving showering care from a hospice bath aide. Caregiver S1 present is stated to have immediately called 911 prior to notifying administrator Maria Tente who in turn notified R1's responsible party and attorney-in-fact. R1 was brought to MemorialCare Saddleback Hospital and admitted until January 7, 2026. R1 was re-admitted on hospice upon their return to the facility. Test and examination performed at the hospital appear to indicate that the fall was the result of a stroke. No delay in calling the paramedics has been evidenced during the investigation. Adequate incident reporting to the Regional Office was additionally performed.

As a result, the allegation is found to be Unsubstantiated, meaning that based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported. 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.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

LIC9099 (FAS) - (06/04)

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