306005848-1-12-2026-22-AS-APAO-DQCSG4-20260115125121

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005848
Report Date: 01/12/2026
Date Signed: 01/12/2026 04:27:07 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
02/05/2024 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240205155235

FACILITY NAME:	GOLDEN AGE SENIOR HOMES		FACILITY NUMBER:	306005848
ADMINISTRATOR:	MICO, RICO G.		FACILITY TYPE:	740
ADDRESS:	24982 WILKES PLACE		TELEPHONE:	(562) 338-4099
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	6	CENSUS: 4	DATE:	01/12/2026
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Rico Mico, administrator		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Staff yell at residents
Staff mismanaged resident’s medication
Staff left residents unattended
Staff did not meet resident’s diapering needs
Staff did not provide adequate food service
Facility is unsanitary

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 following up on the investigation of the six allegations listed above. LPA was greeted and granted entry by facility administrator Rico Mico after explaining the purpose of the visit.

The initial complaint investigation visit was conducted on February 9, 2024. During this first visit, LPA accompanied by administrator conducted a tour of the physical plant. Resident and staff records were requested and obtained during the visit.

LPA conducted a follow-up investigation visit on April 19, 2024. During this second visit, LPA conducted or attempted to conduct interviews with all three residents at the time and toured the physical plant. Additional witness interviews were also conducted via telephone over the course of 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-20240205155235

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: GOLDEN AGE SENIOR HOMES	FACILITY NUMBER: 306005848
	VISIT DATE: 01/12/2026

NARRATIVE

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CONTINUED FROM FORM LIC9099
Regarding the allegation that Staff yell at residents, the following has been concluded: Based on observations conducted during three facility visits, LPA failed to observe any instance of staff members yelling at residents. Eleven out of twelve interviews conducted provided no evidence of yelling or inappropriate verbal interactions occurring on behalf of staff either.

Regarding the allegation that Staff mismanaged resident’s medication, the following has been concluded. Interviews with residents, observation of the medication central storage and a review of resident records kept on the premises including medication records was conducted during multiple visits. No firm evidence of improper handling or inadequate assistance with self-administration was found in order to corroborate the allegation. All medication dispensed appears accounted for at the time of the visits.

Regarding the allegation that Staff left residents unattended, interviews and observation conducted on the premises failed to provide any evidence of specific circumstances or date when staff was not present on the premises to provide care and supervision as required. Adequate staffing was present on the premises during each of the three visits conducted.

Regarding the allegation that Staff did not meet resident’s diapering needs, multiple residents diagnosed with incontinence were observed to be admitted and present per a review of resident assessments conducted. No indication of inadequate toileting care or insufficient management of bladder or bowel incontinence were evidenced during the investigation. Interviews conducted also failed to provide evidence or instances of inadequate replacement of diapers as needed.

Regarding the allegation that Staff did not provide adequate food service, the following has been concluded: the food supply on hand was verified on three separate occasions. Additionally staff was observed to be cooking in preparation for upcoming meals and/or cleaning the kitchen after the meals in question. Meal service was confirmed to take place after 5pm on the day of the present visit. No concerns related to food or nutrition were made during the witness interviews conducted.

CONTINUED ON FORM LIC9099-C

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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Control Number 22-AS-20240205155235

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: GOLDEN AGE SENIOR HOMES	FACILITY NUMBER: 306005848
	VISIT DATE: 01/12/2026

NARRATIVE

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CONTINUED FROM LIC9099-C
Regarding the allegation that Facility is unsanitary, the following has been concluded: During the present visit, staff members on duty were observed to be performing cleaning duties in the kitchen and common areas. Bathrooms and bedrooms were free of odors that could be associated with lack of cleanliness or insufficient sanitary measures.

As a result, all six allegations are found to be Unsubstantiated, meaning that although the six allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations 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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