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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005517
Report Date: 04/15/2026
Date Signed: 04/15/2026 04:59:50 PM

Substantiated


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
12/11/2023 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20231211124039
FACILITY NAME:STERLING SENIOR LIVING 2FACILITY NUMBER:
306005517
ADMINISTRATOR:JEREMIAS FILIOFACILITY TYPE:
740
ADDRESS:9608 PUFFIN AVETELEPHONE:
(714) 357-1377
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 6DATE:
04/15/2026
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Kian PascualTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility is in disrepair.
Facility staff failed to properly administer resident’s medications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.

It was alleged facility is in disrepair and facility staff failed to properly administer resident's medications. LPA conducted interviews with staff and residents. LPA reviewed records obtained.

The investigation determined as follows: Regarding the allegation the facility is in disrepair, LPA toured the facility with staff to determine if the facility is clean, safe, sanitary and in good repair. At 11:01AM, LPA observed the cabinet lock under the kitchen sink was not operational. Cleaning agents such as bleach were found to be stored in the cabinet below the sink and acessible to residents in care. Interviews with four out of six residents stated the facility has remained in good repair overall. Interviews with three out of three staff stated there are two maintenace persons who are available to make repairs to the facility as needed.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
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 5
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
12/11/2023 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20231211124039

FACILITY NAME:STERLING SENIOR LIVING 2FACILITY NUMBER:
306005517
ADMINISTRATOR:JEREMIAS FILIOFACILITY TYPE:
740
ADDRESS:9608 PUFFIN AVETELEPHONE:
(714) 357-1377
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 6DATE:
04/15/2026
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Kian PascualTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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2
3
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9
Facility is not adequately staffed.
Facility failed to maintain a complete and accurate resident’s records.
Facility failed to maintain a complete and accurate staff records.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.

It was alleged facility is not adequately staffed, facility failed to maintain a complete and accurate resident's records, and facility failed to maintain a complete and accurate staff records. LPA conducted interviews with staff and residents. LPA reviewed records obtained.

The investigation determined as follows: Regarding the allegation facility is not adquately staffed, it was reported there is insufficient staff to meet the needs of the residents. LPA interviews with four out of six residents stated their needs are being met by staff and there has not been an issue with sufficient staff. Two out of the four residents added they are attended to promptly when needing assistance. The two remaining residents could not be qualified for interviews.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
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 5
Control Number 22-AS-20231211124039
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: STERLING SENIOR LIVING 2
FACILITY NUMBER: 306005517
VISIT DATE: 04/15/2026
NARRATIVE
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 Three out of three staff stated there is sufficient staff coverage and several back up staff is available when needed. LPA record review of the LIC500 indicates there are seven caregivers available or on call with at least two caregivers scheduled to work from 7AM to 7PM and one caregiver scheduled to work from 7PM to 7AM. LPA reviewed schedule indicating two staff during the day shift and one staff during the night shift from May to April 2026.

Regarding the allegation facility failed to maintain a complete and accurate resident’s records, it was reported resident records were incomplete. Record review revealed six out of six resident files included the required documents including admission agreements, physician reports, TB testing, appraisals, personal rights, consent forms, ID form, centrally stored medication and destruction records, and safeguards for personal property/valuables.

Regarding the allegation facility failed to maintain a complete and accurate staff records, it was reported staff records were incomplete. Record review revealed six out of six staff files included the required documents including health screenings, TB testing, background clearance, recent training including First Aid, and personnel applications.

Based on interviews and record review, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of the report was left with the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20231211124039
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: STERLING SENIOR LIVING 2
FACILITY NUMBER: 306005517
VISIT DATE: 04/15/2026
NARRATIVE
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LPA observed a maintenance person arrive at the facility during the visit to repair the broken lock in the cabinet below the sink. LPA did not observe any other physical plant issues during the visit.

Regarding the allegation the facility staff failed to properly administer resident’s medications, LPA reviewed medication administration. Interviews with four out of six residents stated they receive assistance with medication administration. Those four residents added medications are administered as prescribed. One out of three staff stated Administrator Jerry Filio is in charge of providing medications to residents. Record review for Resident 3 (R3) does not indicate on their medical assessment they can administered own injections. Interview with R3 stated they administer their own injections daily since moving into the facility. LPA audited medications for five other residents and did not find any additional discrepancies.

Based on interviews conducted and record review, 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), are being cited on the attached LIC 9099D.

An exit interview was conducted and a copy of the report was left with the facility representative along with appeal rights.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20231211124039
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: STERLING SENIOR LIVING 2
FACILITY NUMBER: 306005517
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/16/2026
Section Cited
CCR
87309(a)
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Storage Space and Access 87309(a)
...the licensee shall ensure that disinfectants, cleaning solutions..., and other similar items which could pose a danger to residents are in locked storage...

The requirement is not met as evidenced by:
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Maintenance person arrived at the facility and repair lock. LPA observed lock operational.
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LPA observed the cabinet under the kitchen sink to be unlocked storing cleaning solutions and accesible to residents in care which poses an immediate health and safety risk to person in care.
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Type A
04/16/2026
Section Cited
CCR
87465(a)(1)
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Incidental Medical and Dental Care 87465(a)(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.

This requirement is not met as evidenced by:
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AD provided an updated physician's report indicating R3 is able to self administer injections.
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Based on resident interview and record review, R3 is self administrating insulin shots which the resident is not allowed self administer under the resident's current physician's report which poses an immediate health and safety risk to persons 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: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5