191591729-4-27-2026-28-AS-FFIS-DUMUMC-20260601154207

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191591729
Report Date: 04/27/2026
Date Signed: 04/27/2026 04:48:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/12/2026 and conducted by Evaluator Elena Mallett

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260212125025

FACILITY NAME:	C.M.A.		FACILITY NUMBER:	191591729
ADMINISTRATOR:	AMARSINGHE, SWARNA		FACILITY TYPE:	735
ADDRESS:	18432 GRIDLEY RD.		TELEPHONE:	(562) 860-2479
CITY:	ARTESIA	STATE: CA	ZIP CODE:	90701
CAPACITY:	48	CENSUS: 46	DATE:	04/27/2026
		UNANNOUNCED	TIME BEGAN:	03:50 PM
MET WITH:	Administrator-Manel Amarasinghe		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff did not safeguard residents’ personal belongings.
Staff did not ensure to provide residents with activities.
Staff opened resident mail.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elena Mallett conducted a subsequent unannounced complaint investigation visit for the allegations listed above. The initial investigation was conducted on 02/17/2026. LPA met with the Administrator Manel Amarasinghe and explained the reason for the visit.

On today’s visit, LPA obtained a copy of the staff and client roster and interviewed Administrator and Staff #1(S1) to Staff-#4 (S4). LPA toured the physical plant and did not observe any health and safety concerns.

On 02/17/2026, LPA conducted the initial investigation which consisted of interviews with the Administrator, staff #1 (S1) to staff #5 (S5) and with client #1 (C1) to client #5(C5), a tour of the physical plant, and a review of C1's facility file.

See LIC 9099 -C continuation page

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

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 28-AS-20260212125025

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: C.M.A.	FACILITY NUMBER: 191591729
	VISIT DATE: 04/27/2026

NARRATIVE

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The documents collected for the investigation were staff and client rosters, documents from C1's file (Personal Inventory List, Emergency Identification Sheet, Physician’s Report, Needs and Services Plan), the facility Activity Calendar for December 2025, January 2026 and February 2026 and a Confirmation Letter from the local school about group activities to be offered to clients at the facility during the period of 2025-2026. LPA did not observe any health and safety concerns during visit.

Regarding Allegation: Staff did not safeguard residents’ personal belongings: It is alleged that staff threw away a client’s personal belongings without asking permission or explanation, which consisted of C1’s wheelchair, vitamins and mouthwash. Four (4) out of five (5) clients(C2-C5) interviewed stated the staff never threw away any client’s belongings without asking clients’ permission first. One (1) out of five (5) clients, C1, stated the staff took C1’s herbal tea mouthwash away because it might conflict with C1’s medication and then never returned item. C1 stated that a wheelchair and clothes were taken from C1’s room to be donated and that C1 had authorized the removal of both items. C1 states herbal tea mouthwash was removed from C1’s room and not returned. C1 did not corroborate that staff removed any vitamins from C1’s room. Family member of C1 was interviewed and confirms C1’s account of the disposal of C1’s wheelchair and bag of clothes. Family member confirmed C1 agreed to the removal of C1’s items. C2 states staff is very helpful to C2, staff go through C2’s items with C2 to assist in cleaning up C2’s room. C2 staff always ask before throwing anything away. The Administrator and four (4) out of four (4) staff deny the allegation and state clients’ personal belongings are always safeguarded and are never thrown away without asking for the client’s permission. Administrator confirms that a wheelchair and a bag of clothes were taken from C1’s room with C1’s permission and donated. Administrator and four (4) out of four (4) staff denies that vitamins were taken from C1’s room. Staff that perform housekeeping of C1’s room confirmed having seen the herbal tea mouthwash, but stated the item was not removed from C1’s room. LPA’s review of C1’s inventory sheet did not list a wheelchair or a bag of clothes. LPA did not observe a wheelchair, vitamins or mouthwash on the inventory list. The investigation did not reveal that staff are not safeguarding clients’ personal belongings.

See LIC 9099 -C continuation page

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260212125025

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: C.M.A.	FACILITY NUMBER: 191591729
	VISIT DATE: 04/27/2026

NARRATIVE

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Allegation: Staff did not ensure to provide residents with activities: It is alleged that staff are not providing the clients with activities. Five out five clients (C1-C5) interviewed could not corroborate this allegation. Clients stated the facility has activities such as games, music, language arts, hygiene and health curriculum, drawing and exercise are offered in a trailer located in the parking lot or in the dining area if clients choose to participate. LPA observed activities being held during the complaint visit by a contracted third party with facility staff present. The facility has a contract with the local school district to conduct activities. LPA spoke to a staff person from the local school district who conducts activities and confirmed activities are provided to facility clients and confirmed the activities scheduled for the time period August 12, 2025, through May 20, 2026. LPA was provided with the 30-Day Facility Activity Calander for the months of December 2025, January and February 2026. Materials such as games crafts and books were observed by LPA for clients to engage in these activities. The administrator and all staff (S1-S5) interviewed denied the allegation that activities are not being provided. The investigation revealed that staff are providing clients with activities.

Allegation: Staff opened resident’s mail: It is alleged that staff opened up C1’s mail before giving it to C1. LPA interviewed Administrator, who stated the protocol is for the mail to be delivered to clients’ room unopened. If client is not present in the client’s room to receive client’s mail the mail comes back to the Medication room to be retrieved by client upon client’s return to the facility. . The mail remains unopened in the medication room. Administrator and five(5) out of five (5) staff (,S1-S5), deny that any client is given mail that has been opened by a staff member. Five (5) out five (5) staff (S1-S5) deny ever opening a client’s mail before it is given to them. LPA interviewed five clients, five (5) out of five (5) clients (C1-C5), stated the clients mail is received unopened. None of the clients could corroborate this allegation. LPA observed unopened mail placed on clients ’beds in two client rooms. The investigation revealed that staff do not open client mail and mail is delivered to clients unopened.

Based on statements, interviews conducted with staff and clients, LPA’s observations and record review there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held with Administrator Manal Amarasinghe and a copy of this Licensing report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC9099 (FAS) - (06/04)

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