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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191800001
Report Date: 11/24/2025
Date Signed: 11/24/2025 05:25:44 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
11/19/2025 and conducted by Evaluator Luis DeLeon
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251119132345
FACILITY NAME:HOLLENBECK PALMSFACILITY NUMBER:
191800001
ADMINISTRATOR:DIANA MEDINAFACILITY TYPE:
741
ADDRESS:573 S. BOYLE AVETELEPHONE:
(323) 263-6195
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY:185CENSUS: 164DATE:
11/24/2025
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:President CEO Morris ShockleyTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff are not distributing resident's medication as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Ellena Mallett and Luis De Leon conducted an initial unannounced complaint investigation visit for the allegation listed above. LPA met with President CEO Morris Shockley and explained the reason for the visit.

The investigation consisted of the following: On today’s visit, LPAs Ellena Mallett and Luis De Leon toured the physical plant with assistance of Odily Franklin, Assisting Living Coordinator. LPA’s obtained the current client and staff roster, Admission Agreement, Physician’s Report, Physician’s Order, MARs log, Needs and Service Plan, Stored Medication and Destruction Record.

Report continues on page LIC-9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025
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 2
Control Number 28-AS-20251119132345
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: HOLLENBECK PALMS
FACILITY NUMBER: 191800001
VISIT DATE: 11/24/2025
NARRATIVE
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Regarding allegation: Staff are not distributing resident's medication as prescribed.

It is alleged that the facility is not properly distributing residents in care with prescribed medication. The investigation reveals the following: Interview with ten (10) out of ten (10) residents denied the above allegation. All residents stated that staff has not ever missed any medication. R5 stated that R5 has observed staff coming to dining area to distribute prescription to residents. R5 added that staff “never ever forgot to give wife medication.” R5 added that staff is very conscientious about medication. R4 stated that residents complain about food, but R4 has never heard any complaints about prescription not being administered to residents. LPAs interviewed W1 who stated that staff has responded to R1’s call for assistance in a timely manner. In addition, W1 stated that staff have never forgotten to give R1’s medication. Interviews with staff revealed that ten (10) out of ten (10) staff denied above allegation. Interview with staff revealed that following staff has a two-hour window before and after the prescription is scheduled to be distributed to residents. Staff try to locate residents by phone or search in common areas. If resident is not located, charge nurse is notified and charge nurse reports it to doctor for missed medication. S1 stated that after two-hour window, the prescription is destroyed and missed medication is documented in the Stored Medication and Destruction Record. S1 stated that medication is destroyed in order to prevent Med Tech confusion and to prevent residents from receiving a double-doses for the next medication dose. Staff stated that residents who are going to be absent from facility are given prescriptions to take with them, and family is instructed to distribute prescription to residents. LPAs reviewed three (3) residents’ prescriptions and did not find any health and safety risks to residents in care. Based upon the investigation, client and staff interviews, document review, and LPA observations, the facility is distributing resident’s medication as prescribed.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.



Exit interview held with Erika Castile, Vice President, COO. A copy of the report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025
LIC9099 (FAS) - (06/04)
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