306005630-10-10-2025-22-AS-MSTC-DNT4GZ-20251126180622

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005630
Report Date: 10/10/2025
Date Signed: 10/10/2025 02:57:48 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
07/23/2021 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210723134206

FACILITY NAME:	STERLING SENIOR COMMUNITY I		FACILITY NUMBER:	306005630
ADMINISTRATOR:	PASCUAL, KIAN		FACILITY TYPE:	740
ADDRESS:	6081 IVORY CIRCLE		TELEPHONE:	(714) 357-1377
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92647
CAPACITY:	6	CENSUS: 6	DATE:	10/10/2025
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Kian Pascual		TIME COMPLETED:	01:59 PM

ALLEGATION(S):

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Resident sustained injury while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint allegation above. LPA Haley was greeted by staff and explained the reason for the visit upon entering the facility. At the beginning of the visit, LPA was led on a tour of the facility by staff. Observations were made and photos were taken.

Regarding the complaint allegation above, interviews were conducted with staff, resident, a witness, and documents were reviewed. Attempts were made to interview other individuals who could possibly provide details on the complaint allegation, and calls/emails were not returned and/or contact information LPA received was no longer working. Resident 1 (R1) could not be interviewed, as R1 passed away after the incident. A death certificate for R1 was provided. R1’s death was not related to the injury suffered while in care.

During the investigation, 4 of 4 individuals including staff were unable to recall any corroborating information about the incident that occurred on July 21, 2021, involving R1.
Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025

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-20210723134206

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 COMMUNITY I	FACILITY NUMBER: 306005630
	VISIT DATE: 10/10/2025

NARRATIVE

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Two staff members who were interviewed did not recall specific details of the incident; however, both staff members did remember the resident and vaguely remembered the incident that occurred on July 21, 2021. The resident who were here at that time did not have any information to provide regarding R1 or the incident.
Document review revealed the following: Per SOC341 dated July 23, 2021 – Per EMS, patient was found on the floor for an unknown amount of time due to unwitnessed fall. Patient has forehead laceration due to fall.

Per incident report provided by the facility, dated July 22, 2021 – Around 1:00am a caregiver found R1 sitting on the floor. The facility staff member called hospice and a staff from Compassionate Care Hospice told facility staff to call 911. 911 was called and the resident was sent to Hoag Memorial Hospital in New Port Beach.

Although R1 did fall and suffer an injury, it is unclear if the fall and injury is related to neglect of R1’s care needs.

Based on the information gathered during the investigation through interviews and document review, the Department 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 evidence to prove or refute the alleged violations occurred; therefore, the allegation is deemed Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025

LIC9099 (FAS) - (06/04)

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