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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005948
Report Date: 01/09/2026
Date Signed: 01/09/2026 10:49:19 AM

Substantiated


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
12/18/2025 and conducted by Evaluator Edward Kim
COMPLAINT CONTROL NUMBER: 22-AS-20251218142242
FACILITY NAME:AEGIS LIVING DANA POINTFACILITY NUMBER:
306005948
ADMINISTRATOR:NAZARETH, SHEILAFACILITY TYPE:
740
ADDRESS:26922 CAMINO DE ESTRELLATELEPHONE:
(949) 488-2650
CITY:DANA POINTSTATE: CAZIP CODE:
92624
CAPACITY:76CENSUS: 61DATE:
01/09/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Executive Director Eric MedorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff was verbally aggressive to resident.
INVESTIGATION FINDINGS:
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On January 9, 2026, at 9:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced subsequent complaint visit to deliver findings at the facility. LPA Kim met with Executive Director (ED) Eric Medor and explained the purpose of the visit.

The investigation consisted of the following. LPA Kim toured the facility with ED Medor. LPA Kim reviewed and obtained copies of resident roster, staff roster, and one resident’s record, which include: Identification and Emergency Information, incident report, progress notes, Physician's Report, Needs and Services Plans/Reappraisal, and other pertinent records. LPA reviewed and obtained two staff records which include: LIC501/Job Application and contact information. LPA conducted interviews with one resident, four staff, and one witness.

The investigation revealed the following:
Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
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-20251218142242
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: AEGIS LIVING DANA POINT
FACILITY NUMBER: 306005948
VISIT DATE: 01/09/2026
NARRATIVE
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Allegation: Staff was verbally aggressive to resident

It is alleged that the staff member was aggressively communicating with the resident and in close proximity of the resident.

Based on record reviews, the facility progress note stated on December 18, 2025, resident attempted to use the stairway to come down the stairs, but S1 attempted to redirect resident to use the elevator. R1 refused to listen and was speaking aggressively towards S1. S1 raised their voice which led resident to cry and their responsible party (RP) escorted them out of the facility. The resident spent the night at the responsible party’s place. An email dated December 18, 2025, states S1 is under suspension and scheduled to return on Monday, December 22, 2025. The email also stated the facility submitted a report to report the incident to California Department of Social Services Orange County Regional Office, local law enforcement, and the local ombudsman. On December 19, 2025, the facility received a resignation letter from S1.
Based on interviews conducted, three out four staff, one resident, and one witness corroborated that S1 was verbally aggressive with the resident. One staff out of four staff denied the allegation. S3 stated that S1 was yelling with an aggressive angry tone and demanor towards the resident. W1 stated they saw S1 in the face of the resident yelling in anger. S2 and S4 were not present at the time of the incident but confirmed they heard that S1 was yelling at the resident.

Based on the information gathered, there is sufficient evidence gathered to corroborate the above allegation. It is determined that three out of four staff corroborated that the staff was verbally aggressive to resident. It is also determined through progress notes and email correspondence, that the incident did occur where the staff was verbally aggressive with the resident.

Therefore, based on LPA's interviews and the records reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Staff was verbally aggressive to resident deemed SUBSTANTIATED as per the California Code of Regulations, Title 22, Division 6, Chapter 8. A deficiency is being cited on the attached LIC9099D.

Exit interview was conducted, and a copy of the report, LIC9099D, LIC811s, and the appeal rights were provided to Executive Director Eric Medor.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20251218142242
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: AEGIS LIVING DANA POINT
FACILITY NUMBER: 306005948
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/30/2026
Section Cited
CCR
87468.1(a)(3)
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87468.1(a)(3) ...Residents... shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions ....

This requirement is not met evidenced by:
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Licensee states they will have a training session with staff on the topic of how staff should interact with residents in de-escalation situations and submit the plan and sign-in sheet to CCLD via email to edward.kim@dss.ca.gov by POC due date January 30, 2026.
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Based on record review and interviews, the licensee did not comply with the section cited above. S1 was verbally aggressive with R1. This poses a potential health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2026
LIC9099 (FAS) - (06/04)
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