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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197602106
Report Date: 03/19/2025
Date Signed: 03/19/2025 05:51:15 PM

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
03/12/2025 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250312101947
FACILITY NAME:PINNACLES AT BURTON, THEFACILITY NUMBER:
197602106
ADMINISTRATOR:CHANEL ANN SANCHEZFACILITY TYPE:
740
ADDRESS:8750 BURTON WAYTELEPHONE:
(310) 278-9720
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY:200CENSUS: 30DATE:
03/19/2025
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Chanel Sanchez/Executive DirectorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Licensee did not provide copies of resident records in a timely manner.
INVESTIGATION FINDINGS:
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On 3/19/2025 at approximately 10:40 AM, LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Chanel Sanchez / Executive Director. LPA Iniguez explained the purpose of this visit.


Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Staff Interview (S#1) and Witnesses Interview (W#1). LPA obtained and reviewed the following documents: Resident Roster, Personnel Roster and (W#1) electronic records request.


Evaluation Report continues LIC 9099-C

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
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 4
Control Number 11-AS-20250312101947
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: PINNACLES AT BURTON, THE
FACILITY NUMBER: 197602106
VISIT DATE: 03/19/2025
NARRATIVE
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Investigation Revealed the Following:

Allegation: Licensee did not provide copies of resident records in a timely manner

The details of the complaint alleged that facility staff did not provide copies of (R#1)’s records in a timely manner.




On March 19, 2025, at approximately 1:30 PM, LPA Iniguez observed the e-fax cover sheet from (W#1) dated 2/24/25 at around 5:30 PM. This cover sheet requested records regarding (R#1), and the e-fax transmission was successful.

On March 13, 2025, at approximately 1:00 PM, during an interview with witness 1 (W#1), (W#1) stated that they represent (R#1)’ Power of Attorney (W#2). On February 24, 2025, they had requested copies of (R#1)’s file from the facility, but the facility had not responded to their request. (W#1) reported that they called the facility on March 5, March 6, March 7, March 10, March 11, and March 12 to follow up on the records, but the facility did not address their requests. On March 13, a facility staff member emailed (W#1) partial records related to (R#1). However, (W#1) has still not received the complete records they requested. On 3/19/2025, at approximately 10:30 AM, LPA contacted (W#1). He asked them if the facility had sent them all the required records. (W#1) stated no, "I have only partial records, not everything we have requested".

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20250312101947
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: PINNACLES AT BURTON, THE
FACILITY NUMBER: 197602106
VISIT DATE: 03/19/2025
NARRATIVE
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On March 19, 2025, at approximately 11:15 AM, during an interview with Executive Director (A#1), she stated that she was not aware of (W#1)’s records request regarding (R#1), however, (A#1) stated that as 3/18/25, they send some of the records to (W#1). In addition, (A#1) stated that she will send all the records today.

On March 19, 2025, at approximately 11:45 AM, during an interview with facility staff (S#1). They mentioned that they had received a records request from (W#1) and were currently working on it since they had just located (R#1)’s records. (S#1) also noted that they had already sent some records to (W#1) on March 18, 2025.


During this investigation, LPA found sufficient evidence to support the above-mentioned allegation.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D).

An exit interview was conducted, and a copy of the Complaint Report was given to Chanel Sanchez/Executive Director.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20250312101947
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: PINNACLES AT BURTON, THE
FACILITY NUMBER: 197602106
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/24/2025
Section Cited
CCR
87506(c)(1)
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87506 Resident Records
(c) All information and records obtained from or regarding residents shall be confidential.(1) The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative.
This requirement was not met as evidence by:

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Licensee will ensure to follow Tittle 22 Regualtions at all times. As plan of correction, facility will send (R#1)'s requested records to (W#1). Proof of correction will be confirmed with (W#1) before poc due date.
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Based on a review of records and interviews, the facility staff failed to ensure (R#1)'s designated representative did not get their records upon request.
This poses a potential health and safety risk to all residents 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.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4