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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005914
Report Date: 03/20/2026
Date Signed: 04/28/2026 08:32:45 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
01/16/2026 and conducted by Evaluator RoseMarie Ruppert
COMPLAINT CONTROL NUMBER: 22-AS-20260116161217
FACILITY NAME:SENIOR'S RETREAT, INC.FACILITY NUMBER:
306005914
ADMINISTRATOR:SMITH, LORNAFACILITY TYPE:
740
ADDRESS:312 GUAVA PLACETELEPHONE:
(714) 332-0685
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:6CENSUS: 2DATE:
03/20/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Lorna Smith, AdministratorTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Staff did not provide an accurate dosage of medication to resident.

***This is an amended report***
INVESTIGATION FINDINGS:
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LIcensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by Administrator (AD) Lorna Smith and explained the purpose of the visit.

LPA reviewed the following documents for Resident #1 (R1): Identification and Emergency Information Form, Physician's Report, Hospice paperwork and orders, Admission Agreement, Centrally Stored Medication Log, Medication Administration Record, Progress Notes and Medication Release Record from the prior facilty. The Physician's Report form January 6, 2026 states R1's diagnosis is Neurocognitive disorder with Lewy bodies, that the resident was not ambulatory and required a walker and wheelchair. The assessment states R1 must have 24/7 supervision and assistance with Activities of Daily Living (ADLs) and medications. Resident received hospice services upon admission to the facility on December 14, 2025. R1 had recently started hospice services on December 3, 2025. R1 required two-person assist for transfers.
(Continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
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 3
Control Number 22-AS-20260116161217
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: SENIOR'S RETREAT, INC.
FACILITY NUMBER: 306005914
VISIT DATE: 03/20/2026
NARRATIVE
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(Continued from LIC 9099)

Review of the Hospice & Facility Integrated Plan of Care shows a hospice nurse would assess and conduct case management visits once per week and a bath aide would assist with personal grooming, hygiene and bathing twice a week. Resident #1 (R1) changed hospice agencies on December 29, 2025.

It was alleged that Staff did not provide an accurate dosage of medication to resident. LPA reviewed the Centrally Stored Medication and Destruction Record (CSMDR) from December 14, 2025 to January 14, 2026. R1 began taking Seroquel on December 23, 2025. Per review of text messages between Administrator (AD) and Responsible Party (RP); on December 28, 2025 AD requested to increase Seroquel dosage from 2 tablets daily to three; due to combative behavior. RP requested staff only give R1 one tablet per day. A text from December 29, 2025 between RP and AD stated NuPlazid medication would be ordered for R1 and received by January 5, 2026. Text messages from January 5, 2026 relayed NuPlazid had not been received and RP contacted pharmacy to expedite a new order to the facility. The medication was delivered to the facility and a photo was sent of the packaging. The second medication order also arrived at the facility a few days later.

Interview of three of three staff denied the allegation that facility was over medicating resident. Staff gave the dosage requested by RP. One of two witnesses confirmed the allegation. One of two witnesses could not confirm, nor deny the allegation. Thus the allegation that Staff did not provide an accurate dosage of medication to resident is Unsubstantiated.

Based on LPA record review, interviews and observations the allegations may have happened or are valid, but there is not a preponderance of evidence to prove the alleged violations occurred. Therefore the allegations that Staff did not provide an accurate dosage of medication to resident and Staff restrain resident in chair are Unsubstantiated.

An exit interview was conducted with Lorna Smith, Administrator and a copy of this report and LIC 811 was provided to the facility.

***This is an amended report.***
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260116161217
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: SENIOR'S RETREAT, INC.
FACILITY NUMBER: 306005914
VISIT DATE: 03/20/2026
NARRATIVE
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(Continued from LIC 9099-C)

(The text on this page has been moved to the amended LIC 9099-C)

***This is an amended report.***
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3