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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006743
Report Date: 11/10/2025
Date Signed: 11/10/2025 03:14:17 PM

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
11/04/2025 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251104153925
FACILITY NAME:LA SIERRA COTTAGEFACILITY NUMBER:
306006743
ADMINISTRATOR:MANIAGO, MARIEFACILITY TYPE:
740
ADDRESS:26885 LA SIERRA DRIVETELEPHONE:
(917) 386-5767
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 5DATE:
11/10/2025
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Marie Maniago, administratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff do not properly safeguard harmful material
INVESTIGATION FINDINGS:
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13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of investigating the two allegations listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Marie Maniago was notified by phone and arrived later to assist with the visit.

During the visit, LPA accompanied by facility staff conducted a tour of the physical plant. There are currently five residents in care. All five bedrooms were visited, along with one shared bathroom, living room, dining room and kitchen which constitute the other areas accessible to residents in care. Three resident interviews and three staff interviews were conducted during the visit.

CONTINUED ON FORM LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
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 5
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
11/04/2025 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251104153925

FACILITY NAME:LA SIERRA COTTAGEFACILITY NUMBER:
306006743
ADMINISTRATOR:MANIAGO, MARIEFACILITY TYPE:
740
ADDRESS:26885 LA SIERRA DRIVETELEPHONE:
(917) 386-5767
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 5DATE:
11/10/2025
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Marie Maniago, administratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not properly trained
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of investigating the two allegations listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Marie Maniago was notified by phone and arrived later to assist with the visit.

During the visit, LPA accompanied by facility staff conducted a tour of the physical plant. There are currently five residents in care. All five bedrooms were visited, along with one shared bathroom, living room, dining room and kitchen which constitute the other areas accessible to residents in care. Three resident interviews and three staff interviews were conducted during the visit.

CONTINUED ON FORM LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20251104153925
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: LA SIERRA COTTAGE
FACILITY NUMBER: 306006743
VISIT DATE: 11/10/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099-A
Regarding the allegation that Staff are not properly trained , the following has been concluded: There are three caregivers staffed at the facility currently. Staff member S1 was previously employed at a licensed location operated by the licensee (306006329). Annual training for 2023, 2024 and 2025 was reviewed and verified to include required themes in sufficient hourly quantities for all three years.

Staff members S2 and S3 both show a date of hire of October 20, 2025. Their respective initial training was reviewed to include dementia care, postural supports, medication training as well as housekeeping, sanitation, food preparation, infection control as well as emergency safety training. First aid and CPR training was also reviewed to be present for staff members currently being scheduled.

As a result, the allegation is found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. 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: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20251104153925
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: LA SIERRA COTTAGE
FACILITY NUMBER: 306006743
VISIT DATE: 11/10/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Staff do not properly safeguard harmful material, the following has been concluded: During the tour of the physical plant, LPA and facility staff observed the following: Resident R1 has laundry detergent pods stored on the upper level of their closet. Per staff statement, R1 and their family have requested them to do their own laundry with minimal staff assistance. Per a review of R1's most recent assessment, R1 does not lack hazard awareness or impulse control and their safety would not be at risk if the resident had access to cleaning solutions and/or poisonous substances.

Resident R2 has isopropyl alcohol accessible. Identically per a review of R2's most recent assessment, R2 does not lack hazard awareness or impulse control and their safety would not be at risk if the resident had access to cleaning solutions and/or poisonous substances. None of the residents currently admitted appear to have been assessed to require restricted access to toxins.

There are however a few bottles of cleaning products accessible under the bathroom's sink which are initially observed to be accessible during the visit. One recently discharged resident (R3) was assessed with dementia and not confirmed to have sufficient cognitive abilities to be able to access such products. One type B deficiency is therefore cited on the attached form LIC9099-D and cleared during the visit. Once pointed out, it was immediately remedied by facility staff with the installation of a safety lock. Additional dangerous items such as sharp utensils are verified to be secure in two kitchen drawers. Kitchen cleaning supplies are also secured.

Based on observation and staff interviews, the allegation that Staff do not properly safeguard harmful material is found to be Substantiated, meaning that the preponderance of evidence standard has been met. therefore. See LIC9099-D for cited deficiency per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20251104153925
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: LA SIERRA COTTAGE
FACILITY NUMBER: 306006743
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2025
Section Cited
CCR
87309(c)
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Per CCR87309(c), the licensee shall implement reasonable interventions in order to ensure that (...) potentially toxic substances, (...) are stored so as not to pose a hazard to residents.
This requirement is not met as evidenced by:
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Licensee installed a safety lock on the bathroom cabinet used for the storage of cleaning products during the present visit. Deficiency cleared during the initial visit.
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Based on observation and interviews conducted, cleaning products were left accessible in the shared bathroom. This constitutes a potential risk to the health, safety and personal rights of individuals 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: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5