306005948-2-3-2025-22-AS-AJLO-DE4TBA-20250221133446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005948
Report Date: 02/03/2025
Date Signed: 02/03/2025 02:40:27 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/28/2025 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250128082334

FACILITY NAME:	AEGIS LIVING DANA POINT		FACILITY NUMBER:	306005948
ADMINISTRATOR:	NAZARETH, SHEILA		FACILITY TYPE:	740
ADDRESS:	26922 CAMINO DE ESTRELLA		TELEPHONE:	(949) 488-2650
CITY:	DANA POINT	STATE: CA	ZIP CODE:	92624
CAPACITY:	76	CENSUS: 59	DATE:	02/03/2025
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Sheila Nazareth, Iona Soptirean		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Due to lack of supervision, resident was assaulted by another resident

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad and Nancy Guillen for the purpose of investigating the above-mentioned complaint allegation. LPAs met with Administrator (AD) Sheila Nazareth and Care Director (CD) Iona Soptirean, discussed the purpose of the inspection, and explained the allegation.

The investigation into the allegation that due to lack of supervision, resident was assaulted by another resident revealed the following: During the course of the investigation, LPAs inspected the facility, interviewed AD, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Individualized Service Plan dated December 10, 2024, the facility’s recent communications with R1’s doctor, and the facility’s progress notes for R1.

CONTINUED

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025

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-20250128082334

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: AEGIS LIVING DANA POINT	FACILITY NUMBER: 306005948
	VISIT DATE: 02/03/2025

NARRATIVE

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It was alleged that a resident was hit by another resident and no injuries were sustained. LPAs inspected the facility, conducted health and safety checks on residents, and observed no health and safety issues. LPAs interviewed AD who stated that on January 11, 2025, R1 was agitated and aggressive in the memory care unit, R1 was taken on a walk through the assisted living section by Staff #1 (S1) to calm down, an altercation allegedly occurred between R1 and Resident #2 (R2) in the assisted living section, and R1 was redirected back to the memory care unit. However, AD did not witness the alleged altercation. LPAs interviewed S1 who denied there was an altercation between R1 and R2 and stated that on January 11, 2025, S1 was holding R1’s hand while taking R1 on a walk through the assisted living section and R1 accidentally bumped into R2 while they were walking by R2, R1 was not aggressive, there was no physical or verbal altercation, and the bump was minor and did not lead to any injuries or falls. R1 is no longer at the facility. LPAs interviewed R2 and another resident who witnessed the alleged incident who did not corroborate the allegation. LPAs interviewed six other residents and did not obtain information corroborating any concerns about safety, staffing, or care and supervision. LPAs reviewed R1’s Individualized Service Plan dated December 10, 2024, the facility’s recent communications with R1’s doctor, and the facility’s progress notes for R1 which indicate that the facility has been working with R1’s doctor and family to address R1’s behaviors. The information obtained showed that the incident did not occur as alleged and that instead R1 accidentally bumped into R2.

The Department has investigated the above allegation and found it to be Unfounded, meaning the allegation was false, could not have happened, or is without reasonable basis. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025

LIC9099 (FAS) - (06/04)

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