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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005565
Report Date: 11/10/2025
Date Signed: 11/10/2025 11:24:01 AM

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
11/03/2025 and conducted by Evaluator Celine Rodriguez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251103084921
FACILITY NAME:AK AND DAVID SENIOR CAREFACILITY NUMBER:
306005565
ADMINISTRATOR:CATACUTAN, MARY JEANFACILITY TYPE:
740
ADDRESS:24302 BARK STTELEPHONE:
(949) 677-3394
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 5DATE:
11/10/2025
UNANNOUNCEDTIME BEGAN:
07:27 AM
MET WITH:Facility Administrator - Mary Jean Catacutan TIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Staff physically restrained resident
Facility accessing resident funds without consent
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Celine Rodriguez initiated an unannounced 10-day visit to the facility for the complaint and delivered the findings. LPA Rodriguez explained the purpose of today's visit, was greeted, and granted entry by staff on duty. For this visit, LPA Rodriguez met with facility administrator (AD) Mary Jean Catacutan.

During the investigation, LPA Rodriguez toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed.

It was alleged that staff physically restrained resident. 5 out of 5 resident interviews did not corroborate with the allegation by denying of staff restraining resident and reporting that staff are "good" and "nice". LPA conducted an interview with resident 1 (R1) who denied of being restrained. 3 out of 3 staff interviews did not corroborate with the allegation by stating that staff do not restrain residents.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
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-20251103084921
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: AK AND DAVID SENIOR CARE
FACILITY NUMBER: 306005565
VISIT DATE: 11/10/2025
NARRATIVE
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Per documentation review, resident (R1) had a neck fracture prior to admission into the facility and wore a neck brace, and despite R1 experiencing pain, R1 declined in wanting to take medications prescribed by R1's doctor, to which R1 confirmed this to be true. On 10/28/25, R1 was sent to the hospital due to abdominal pain, however voluntarily declined in wanting to return back to the facility.

It was alleged that facility is accessing resident funds without consent. 5 out of 5 resident interviews did not corroborate with the allegation by stating that either they, or their families have access to their funds, and that their financial information is not provided to the facility staff. LPA conducted an interview with R1 who denied of staff accessing funds by confirming that no information was ever provided to staff regarding R1's funds and that R1 only had access to own funds. 3 out of 3 staff interviews did not corroborate with the allegation by stating that facility does not handle resident funds. Per record review, LPA verified that facility does not safeguard resident's financial funds.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, these allegations are UNFOUNDED, meaning that these allegations wer false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with AD Catacutan.

A copy of this report was provided and explained.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2