191600093-10-23-2025-11-AS-SCIS-DNDQCZ-20251113110356

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600093
Report Date: 10/21/2025
Date Signed: 10/23/2025 04:17:21 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/16/2025 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20251016103839

FACILITY NAME:	BAY BREEZE CARE		FACILITY NUMBER:	191600093
ADMINISTRATOR:	HONEYLET URREA		FACILITY TYPE:	735
ADDRESS:	1653- 55 SANTA FE AVE		TELEPHONE:	(562) 432-8033
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	76	CENSUS: 59	DATE:	10/21/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Honeylet Urrea		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Staff withheld a resident's P&I funds.

INVESTIGATION FINDINGS:

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On October 21, 2025, Licensing Program Analyst (LPA) Pamela Bunker conducted an initial visit to gather information regarding the above allegations. LPA met with Honeylet Urrea, Interim Administrator. LPA explained the purpose of the visit. LPA was granted entry into the facility.

The investigation consisted of the following: On 10/21/2025, the following documents were reviewed and obtained as part of the investigation: Personnel Report (dated 09/16/2025), Resident Roster (dated 10/21/2025), Admission Agreement (dated 08/23/2011), Identification and Emergency Information (dated 08/24/2011), Physician’s Report (dated10/01/2025), Medical Assessment (dated 06/27/2025), Medication Administration Records (MARs) (10/01/2025 -present), Appraisal & Needs and Services Plan (dated 01/01/2025), Functional Capability Assessment (dated 01/01/2025 ), Preplacement Appraisal Information (dated 01/01/2025), Personal Rights (dated 08/23/2011), Consent Forms (dated 08/23/2011), House Rules (dated 03/25/2021), Record of Client's/Resident's Safegurded Cash Resources (dated 01/01/2025 - 10/21/2025), See continued LIC9099-C – Page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

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 3

Control Number 11-AS-20251016103839

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BAY BREEZE CARE	FACILITY NUMBER: 191600093
	VISIT DATE: 10/21/2025

NARRATIVE

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Continued LIC9099-C – Page 2

Behavioral Contract/House Rules Violation – Drug Use/Possession (dated 09/21/2025–10/13/2025)
Unusual Incident Reports (dated 09/17/2025, 09/22/2025, 10/10/2025, 10/15/2025)

On 10/21/2025, between 12:00 p.m. and 4:00 p.m., LPA Pamela Bunker conducted interviews with staff members #1–#4 (S1–S4) and residents #1–#7 (R1–R7) regarding the complaint allegations.

Investigation revealed the following.
Allegation: Staff withheld a resident's personal and incidental funds.
It was alleged that the Staff withheld a resident’s Personal and Incidental (P & I) funds due to a positive drug test. On 10/21/2025, from 12:00 p.m. to 4:00 p.m., the Department conducted interviews with staff #1-#4 (S1-S4). 4 out of 4 staff members stated that staff did not withhold a resident's P & I funds because of a positive drug test. 4 out of 4 staff members confirmed that all residents sign an admission agreement regarding P & I upon or prior to or upon admission. The Department requested and reviewed Resident #1's 1 (R1) file and observed the original copy of the initial admission agreement, as well as a signed and dated Admission Agreement completed on 08/23/2011, and Behavioral Contract/House Rules Violation- Drug Use/Possession dated 09/15/2025-10/13/2025, and Record of Client's/Resident's Safeguarded Cash Resources (dated 01/01/2025 - 10/21/2025) with R1 signature indicating R1' is receiving P & I weekly on a Tuesday of each week. 4 out of 4 staff members confirmed R1 is receiving P & I weekly. 4 out of 4 staff denied the allegation. Based on staff interviews and documentation, there is no evidence supporting the allegation that P & I funds were withheld from Resident #1 due to a positive drug test.

On 10/21/2025, from 12:00 p.m. to 4:00 p.m., the Department interviewed seven residents #1-#7 (R1-R7). 6 out of 7 residents confirmed that they receive their Personal and Incidental (P&I) funds every Tuesday and that they sign for the funds upon receipt. 1 out of 7 resident reported being financially independent, managing their own funds and paying room and board directly. 7 out of 7 residents denied the allegation that staff withheld P & I funds,

Resident interviews support staff statements and documentation, indicating consistent and proper handling of P & I funds. No evidence was found to support the allegation.
See continued LIC9099-C – Page 2

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20251016103839

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BAY BREEZE CARE	FACILITY NUMBER: 191600093
	VISIT DATE: 10/21/2025

NARRATIVE

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Continued LIC9099-C Page 3

Based on interviews, available evidence, observation, information received, and records reviewed, there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is deemed unsubstantiated.

There were no deficiencies cited.

A copy of the Complaint Investigation Report LIC9099 and LIC9099-Cs was provided to Honeylet Urrea, Interim Administrator.

An exit interview was conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

LIC9099 (FAS) - (06/04)

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