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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006715
Report Date: 09/13/2026
Date Signed: 09/13/2026 11:04:27 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
05/12/2026 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20260512142639
FACILITY NAME:ST JUDE CARE HOMEFACILITY NUMBER:
306006715
ADMINISTRATOR:QUIOGUE,MARIAFACILITY TYPE:
740
ADDRESS:10611 CEDARHILL CIRCLETELEPHONE:
(714) 617-0599
CITY:VILLA PARKSTATE: CAZIP CODE:
92861
CAPACITY:6CENSUS: 3DATE:
09/13/2026
UNANNOUNCEDTIME BEGAN:
11:39 AM
MET WITH:Alice DabuTIME COMPLETED:
01:42 PM
ALLEGATION(S):
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Neglect/Lack of Care and Supervision resulted in resident sustaining serious injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility for the purpose of delivering findings regarding the complaint investigation. LPA Haddadin was greeted by staff, Alice Dabu, who granted access to the facility, at which time the purpose of the visit was explained.
On May 12, 2026, the Regional Office received a complaint alleging, “Neglect/Lack of Care and Supervision resulted in resident sustaining serious injury.”
The investigation determined as follows:
Per medical assessment record dated August 8, 2025, Resident 1 (R1) had a prior right femur fracture. R1’s resident appraisal dated July 7, 2025, identified R1 as non-ambulatory, requiring assistance with moving around the facility and supervision and at high risk for fall. R1 required the use of a walker due to paralysis.
On May 8, 2026, R1 sustained a fall in the living room area of the facility.
{****CONTINUE9099C***}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2026
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-20260512142639
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: ST JUDE CARE HOME
FACILITY NUMBER: 306006715
VISIT DATE: 09/13/2026
NARRATIVE
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 Interviews established that one staff member was near the living room when the fall occurred but did not directly observe the fall, while another staff member heard R1 fall from the nearby garage area and subsequently observed R1 on the floor. Staff assisted R1 from the floor and placed them in a seated position. Although staff reported that they did not initially observe bleeding or other visible injuries, R1 reported that their head hurt. Staff asked R1 if they wanted them to call 911; however, R1 requested that their family be contacted instead. Staff did not contact 911 and instead contacted the Facility Administrator (AD), who was not present at the facility. The Facility AD subsequently notified R1’s family member by text message regarding the fall.
At approximately 9:54 A.M., R1 spoke with their family by telephone. During the conversation, the family member observed that R1 did not appear to recall what had occurred and was not communicating as they normally did. Due to the change in R1’s cognitive condition, R1’s family member went to the facility to assess R1 in person and contacted R1’s nurse practitioner. Upon arrival, R1’s family member observed a bruise or bump on the back of R1’s head. R1 also demonstrated confusion and difficulty recalling information.
R1’s nurse practitioner arrived at the facility and assessed R1. The nurse practitioner confirmed that R1 was taking blood thinner medication and that facility staff were aware of this medication. Due to R1’s change in mental status following the fall, the nurse practitioner advised that R1 needed to be transported to the hospital. R1’s family member subsequently transported R1 to the hospital. During the interview with the nurse practitioner, she stated that, based on R1’s condition and diagnosis, R1 should have been transported to the hospital sooner.
Hospital records show that R1 was admitted on May 8, 2026, following the fall with head impact. A CT scan revealed a large subarachnoid hemorrhage, subdural hematoma, and left frontal intracerebral hemorrhage. On May 14, 2026, R1 was enrolled in hospice care following the discharge from the hospital and passed away on May 15, 2026. R1’s death certificate identified the immediate cause of death as Traumatic Intracerebral Hemorrhage.
{CONTINUE 9099C2***}
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20260512142639
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: ST JUDE CARE HOME
FACILITY NUMBER: 306006715
VISIT DATE: 09/13/2026
NARRATIVE
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Based on the preponderance of evidence, the allegation, “Neglect/Lack of Care and Supervision resulted in resident sustaining serious injury,” is Substantiated. The facility is being cited for violating Title 22, Division 6 of the California Code of Regulations.
An immediate civil penalty was assessed per LIC421IM. A Civil Penalty is pending determination by Community Care Licensing Division as per Health & Safety Code 1569.49. An exit interview was conducted and a copy of this report along with LIC809-D, Appeal Rights, Civil Penalty Assessment -LIC 421 IM and the LIC 811, identifying confidential names were provided
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20260512142639
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: ST JUDE CARE HOME
FACILITY NUMBER: 306006715
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/14/2026
Section Cited
CCR
87464(f)(1)
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87464(f)(1)“Basic services shall at a minimum include: (1) Care and supervision…” This requirement was not met as evidenced by record review. Facility staff failed to provide adequate care and supervision to R1, resulting in a
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The Administrator will review all current residents for changes in condition and ensure care plans are updated when additional assistance or supervision is needed.
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fall with a subarachnoid hemorrhage, subdural hematoma, and left frontal intracerebral hemorrhage. This poses an immediate health and safety risk to residents in care.
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Staff will be trained on Section 87464(f)(1). Proof of the completed resident reviews and staff training will be submitted to LPA by the POC due date.
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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: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2026
LIC9099 (FAS) - (06/04)
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