306005908-4-21-2026-22-AS-APAO-DTD6JS-20260421205136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005908
Report Date: 04/21/2026
Date Signed: 04/21/2026 11:19:26 AM

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
09/08/2022 and conducted by Evaluator Cassandra Mikkelson

COMPLAINT CONTROL NUMBER: 22-AS-20220908100901

FACILITY NAME:	WESTMONT OF CYPRESS		FACILITY NUMBER:	306005908
ADMINISTRATOR:	FAYE, SAMUEL		FACILITY TYPE:	740
ADDRESS:	4889 & 4775 KATELLA AVE.		TELEPHONE:	(858) 729-6720
CITY:	LOS ALAMITOS	STATE: CA	ZIP CODE:	90720
CAPACITY:	152	CENSUS:	DATE:	04/21/2026
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Samuel Faye		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff did not seek medical attention for resident in care.
Staff did not continue to treat resident's injury.
Lack of supervision resulting in resident leaving the facility.
Staff is not assisting with resident's laundry needs.
Staff leave resident's room unclean.
Staff are not disposing resident's urine containers.
Staff is not assisting with resident's hygiene needs.
Facility is not following COVID-19 procedures.

INVESTIGATION FINDINGS:

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On 04/21/2026, Licensing Program Analyst (LPA) Cassandra Mikkelson contacted the licensee via phone and email to deliver final findings regarding a complaint that was received on 09/08/2022.

Continued on 9099- C page

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

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-20220908100901

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: WESTMONT OF CYPRESS	FACILITY NUMBER: 306005908
	VISIT DATE: 04/21/2026

NARRATIVE

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Staff did not seek medical attention for resident in care.

Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated.

Staff did not continue to treat resident's injury.

Lack of supervision resulting in resident leaving the facility.

Staff is not assisting with resident's laundry needs.

Staff leave resident's room unclean.

Staff are not disposing resident's urine containers.

Staff is not assisting with resident's hygiene needs.

Facility is not following COVID-19 procedures.

Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

LIC9099 (FAS) - (06/04)

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