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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006400
Report Date: 08/13/2026
Date Signed: 08/13/2026 07:55:04 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
08/07/2026 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260807100406
FACILITY NAME:MG HEIGHTS IFACILITY NUMBER:
306006400
ADMINISTRATOR:RICO, CAROLYNEFACILITY TYPE:
740
ADDRESS:10612 LEXINGTON STREETTELEPHONE:
(657) 298-3008
CITY:STANTONSTATE: CAZIP CODE:
90680
CAPACITY:5CENSUS: 3DATE:
08/13/2026
UNANNOUNCEDTIME BEGAN:
07:25 AM
MET WITH:Mae BarlahanTIME COMPLETED:
08:15 PM
ALLEGATION(S):
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Staff left residents unsupervised.
Lack of Staffing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility and interviewed staff, residents and witnesses as well as reviewed and obtained pertinent documentation such as Personnel Report, Resident physicians reports, Emergency Identification information, Water Bill Notice, Cable bill notice Resident Admission Agreement, and Grocery Receipts.

Regarding allegation Staff left residents unsupervised and lack of staffing, the investigation revealed the following: Facility has three residents in care. Per staff interviews, facility had two staff working back on July 20, 2026 (a full time caregiver and part time caregiver who was a reliever). Per interview with Staff 1 (S1) Staff 1 worked by themselves 24/7 from June 1st- June 18th, 2026 and from July 23rd to August 13th 2026.
CONTINUED ON 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
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 4
Control Number 22-AS-20260807100406
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: MG HEIGHTS I
FACILITY NUMBER: 306006400
VISIT DATE: 08/13/2026
NARRATIVE
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Per interview with S1, another Caregiver (S3) worked by themselves 24/7 on July 21-22, 2026 and an additional caregiver (S4) worked by themselves from June 19th to June 24th. Interviews with Staff 1 and Staff 2 confirmed that Administrator/ Licensee Carolyn Rico was out of the country beginning June 23, 2026. S1 stated that on two occasions (dates were not provided) they had to leave residents unattended while they ran to the store to buy groceries to provide meals for residents due to facility food supply was low. S1 stated they left for a period of time of 30 to 45 minutes. Interview with Witness confirmed that residents were left unattended for period of time.
Based on the information provided, the preponderance of evidence has been met. The following is being cited per Title 22 Regulations.

An exit interview was conducted with Caregiver and report provided to facility representative.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20260807100406
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: MG HEIGHTS I
FACILITY NUMBER: 306006400
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/14/2026
Section Cited
CCR
87411(a)
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Personnel Requirements. (a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This was not met as evidence by lack of staff working in facility. This poses a immediate Health & Safety risk to residents in care.
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POC is for for Licensee to provide a second full time employee working at facility by poc due date 8/14/26. Licensee to provide proof of POC by 8/14/2026 to LPA.
Type B
08/14/2026
Section Cited
CCR
87464(f)(1)
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Basic Services (f) Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This was not met as evidence by residents being left unattended. This poses potential health & safety risk to residents in care
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POC is for Licensee to provide training to staff not to leave residents unattended for their care and safety. POC due date 8/14/26 to LPA
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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.
SUPERVISOR'S NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4