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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191603774
Report Date: 05/08/2025
Date Signed: 05/08/2025 11:15:38 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/03/2025 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250403121056
FACILITY NAME:CANTERBURY, THEFACILITY NUMBER:
191603774
ADMINISTRATOR:DAVE HONEFACILITY TYPE:
741
ADDRESS:5801 WEST CRESTRIDGE ROADTELEPHONE:
(310) 541-2410
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90274
CAPACITY:187CENSUS: 146DATE:
05/08/2025
UNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Dave Hone, Executive DirectorTIME COMPLETED:
11:24 AM
ALLEGATION(S):
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Staff did not repair resident's toilet in a timely manner
INVESTIGATION FINDINGS:
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On 05/08/25 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent, unannounced, complaint visit at this facility to deliver findings regarding the above allegation. LPA met with staff nine Dave Hone Executive Director (S9), and the purpose of the visit was explained.
On 04/11/25 LPA requested and reviewed facility documents, including the following: Resident roster (dated 04/10/25), staff roster (dated 04/11/25), and documentation of a call from a resident's room.
LPA interviewed five (5) out of one-hundred and thirty-seven (137) residents (R1-R5), eight (8) out of two-hundred and ninety-one (291) staff (S1-S8) and one (1) witness.
Investigation revealed the following:
Regarding the allegation, "Staff did not repair resident's toilet in a timely manner", it has been alleged that a resident's toilet was left clogged for 16 hours. On 04/11/25 LPA observed a resident's room, which contains two restrooms. On 04/11/25 LPA interviewed staff five, Rene Cardoza (S5), maintenance supervisor, who confirmed the maintenance team works from 07:00AM to 4:00PM.
Report continues, see LIC9099-C.
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
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-20250403121056
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: CANTERBURY, THE
FACILITY NUMBER: 191603774
VISIT DATE: 05/08/2025
NARRATIVE
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S5 also verified that maintenance staff follow their schedules based on an on-call maintenance staff rotation, indicating that there are on-call maintenance staff continuously available (24/7) to repair any malfunction at this facility. LPA interviewed staff six, Oziel Rodriguez (S6) maintenance staff, who confirmed that S6 repaired the toilet on 03/05/25 (time unknown). LPA interviewed staff seven, Richard Madridejos (S7), who explained that "If it’s a clogged toilet, we have to respond as soon as possible (ASAP)." and that "We don’t tell them to use another toilet in their room, or another toilet down the hall. We have to do that ASAP." On 04/11/25 LPA reviewed front desk call log that noted a resident, or their private caregiver, reported a clogged toilet in their room on 03/04/25 at 5:02PM. LPA reviewed a maintenance work order, noting that the same toilet was repaired on 03/05/25 at 09:13AM. This record review has validated that a resident's toilet was left clogged for 16 hours and 11 minutes (16:11h).
Based on LPAs observations, interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, article 05 are being cited. Please see LIC9099-D.

There has been one (1) deficiency cited during today's visit.

An exit interview was conducted with Dave Hone, executive director (S9) and a copy of this report and appeal rights have been provided.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250403121056
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CANTERBURY, THE
FACILITY NUMBER: 191603774
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2025
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation
(a) The facility shall be...in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This has not been met as evidenced by:
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Licensee and LPA have agreed that Canterbury staff will, moving forward, repair any malfunction or non-functioning items throughout the facility and that the executive director (S9) will inform maintenance staff of expectations. S9 will forward this memo to LPA at Mario.Leon@DSS.CA.GOV
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Based on record review(s), the licensee did not comply with the section cited above as having left a residents' toilet clogged for about 16hrs, which poses/posed a potential health, safety or personal rights risk to persons 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: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3