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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005207
Report Date: 01/07/2026
Date Signed: 01/07/2026 05:54:34 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
08/23/2024 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240823090146
FACILITY NAME:HARVEST RETIREMENTFACILITY NUMBER:
306005207
ADMINISTRATOR:GINGER POFACILITY TYPE:
740
ADDRESS:9011 KNOTT AVETELEPHONE:
(714) 821-4130
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:106CENSUS: 72DATE:
01/07/2026
UNANNOUNCEDTIME BEGAN:
08:11 AM
MET WITH:Rose EnriquezTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff does not ensure hygiene needs are being met resulting in resident developing infections.
Staff leaves resident soiled for extended periods of time.
Staff does not follow resident's dietary plan.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the investigation into the allegations listed above. LPA met with Administrator Rose Enriquez and explained the reason for the visit.

The investigation into the allegation, staff does not follow resident's dietary plan, revealed the following. Resident 1's (R1) physician report dated, May 8, 2024 shows R1 was diagnosed with Alzheimer's disease and type 2 diabetes. R1 was prescribed a low fat and low sodium diet. The Administrator reported that all residents with a prescribed special diet are accommodated. The head chef reported that R1's special diet was accommodated. The head chef reported that the kitchen has a list of all the residents with special diets so all the kitchen staff know who they are. The head chef reported that R1 received a low fat, low sodium diet and had sugar free deserts along with portion control because they were diabetic. The head chef reported that R1 was only served water or tea because they were diabetic. 2 out of 2 kitchen servers reported there is a list showing the residents who are diabetic and require a special diet.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026
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 6
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
08/23/2024 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240823090146

FACILITY NAME:HARVEST RETIREMENTFACILITY NUMBER:
306005207
ADMINISTRATOR:GINGER POFACILITY TYPE:
740
ADDRESS:9011 KNOTT AVETELEPHONE:
(714) 821-4130
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:106CENSUS: 72DATE:
01/07/2026
UNANNOUNCEDTIME BEGAN:
08:11 AM
MET WITH:Rose EnriquezTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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9
Staff did not administer medication to resident as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegation listed above. LPA met with Administrator Rose Enriquez and explained the reason for the visit.

The investigation into the allegation, staff did not administer medication to resident as prescribed, revealed the following. Resident 1 (R1) moved into the facility on July 3,2024 and moved out of the facility on October 31, 2024. A review of R1's Medication Administration Record (MAR) for July, August, September and October 2024 shows that R1 did not receive Clotrimazole 1% topical cream for their evening dose (5:00pm) on July 18, 2024 and did not receive 5 medications for their bedtime dose (8:00pm), Ciclopirox 8% solution, Lisinopril 20 mg, Quetiapine Fumarate 25 mg, Quetiapine Fumarate 50 mg and Rosuvastatin Calcium 5 mg, on July 20, 2024. R1 did not receive 6 medications for their bedtime dose (8:00pm) on September 18, 2024, Ciclopirox 8% solution, Glucerna shake, Lisinopril 20 mg, Quetiapine Fumarate 50 mg, Rosuvastatin Calcium 5 mg and Senna Plus 8.6-50mg.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 22-AS-20240823090146
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: HARVEST RETIREMENT
FACILITY NUMBER: 306005207
VISIT DATE: 01/07/2026
NARRATIVE
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The Administrator and Assistant Administrator reported the medication was administered but not marked in the Medication Administration Record (MAR). The Administrator reported that R1 was seen regularly by her physician and home health nurse. R1 was seen by her primary care physician (PCP) on July 18, 2024, August 15, 2024, September 19, 2024 and October 17, 2024. The Administrator reported that R1 was never sent out to the hospital during their stay at the facility. 4 out of 4 caregivers reported they did not observe any health related issues with R1 during their stay at the facility. Based on the evidence gathered the preponderance of evidence standard has been met therefore the allegation is substantiated. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 22-AS-20240823090146
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: HARVEST RETIREMENT
FACILITY NUMBER: 306005207
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2026
Section Cited
CCR
87468.1(a)(16)
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To receive or reject medical care or other services. This requirement was not met as evidenced by Resident 1 (R1) was not administered medications on July 18, July 20 and September 18, 2024.
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Licensee agrees to train staff (med-techs) on CCR 87468.1 and on the facility's policy and procedure regarding medication administration. Proof to be provided to LPA by POC due date.
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This poses a potential health, safety and personal rights 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: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 22-AS-20240823090146
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: HARVEST RETIREMENT
FACILITY NUMBER: 306005207
VISIT DATE: 01/07/2026
NARRATIVE
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LPA observed the list in the kitchen. 2 out of 2 kitchen servers and the head chef reported that R1 was not served food high in sugar or inappropriate for a diabetic. It was reported that starches, sugary food and food not appropriate for a diabetic were served to R1. It was reported that staff reported to R1's responsible party that R1's glucose level was above 400. No specific dates or times were provided when the inappropriate food was provided or when staff informed the responsible party R1's glucose was above 400. 4 out of 4 caregivers interviewed denied the reports. R1's home health nurse could not corroborate the reports. R1 received home health visits from a nurse daily. LPA reviewed the facility's menu, the facility menu meets title 22 requirements. No incidents were reported involving R1 going to the hospital for any reason. The Administrator reported that R1 was never sent to the hospital while living at the facility. LPA attempted to interview R1 but they did not respond to any questions. None of the evidence gathered supports the allegation, therefore the allegation is unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, staff does not ensure hygiene needs are being met resulting in resident developing infections, revealed the following. It was reported that R1 had multiple urinary tract infections (UTIs) while at the facility and an infection on the abdomen. The Administrator reported that R1's hygiene needs were met and R1 had never been diagnosed with a UTI. R1's physician ordered a urinalysis on August 13, 2024 and on October 17, 2024. R1 had a doctor's visits on August 15, 2024 and on October 17, 2024. Facility records verified this information. The Administrator reported that R1's responsible party requested that R1 be put on an antibiotics prior to the urinalysis being completed in August and October. A review of R1's medicaiton administration record shows R1 was prescribed antibiotics on August 13, 2024 and October 18, 2024. The results of both tests were inconclusive, suggesting both samples were contaminated. The Administrator reported that since R1 was already prescribed and taking antibiotics at the request of the responsible party, R1's physician did not order new tests. The Administrator reported that R1 moved in with redness on their abdomen and the Clotrimazole 1% topical cream was listed on their original physician's report medication list dated May 8, 2024. A review of R1's physician's report verified this information. R1's MAR for July 2024 shows R1 was prescribed Clotrimazole 1% topical cream from July 5 to August 6, 2024. R1's home health nurse reported R1's hygiene needs were being met by staff and stated R1's possible UTI's and redness on the abdomen could not be attributed to lack of care. R1 received home health visits daily. 4 out of 4 caregivers interviewed reported R1's hygiene needs were always met. R1's responsible party did not respond to LPA's request for an interview.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20240823090146
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: HARVEST RETIREMENT
FACILITY NUMBER: 306005207
VISIT DATE: 01/07/2026
NARRATIVE
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Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, staff leaves resident soiled for extended periods of time, revealed the following. It was reported that R1's briefs were not changed timely and R1 was left in soiled briefs for an extended period of time. No dates or times were provided as to when this incident took place. 4 out of 4 caregivers interviewed denied the allegation and reported that R1's incontinence needs were always met. R1's home health nurse reported that they visited R1 at least 5 days a week and R1 was always clean. R1's home health nurse reported that they did not observe any issues with R1's hygiene. The Administrator reported that R1 was well cared for and they always communicated with the responsible party regarding R1's status. R1's responsible party did not respond to LPA's request for an interview. Based on the evidence gathered the allegation is unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6