<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197602370
Report Date: 09/12/2025
Date Signed: 09/15/2025 01:33:21 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
09/09/2025 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250909091421
FACILITY NAME:PINNACLES AT BURTON, THEFACILITY NUMBER:
197602370
ADMINISTRATOR:CHANEL ANN SANCHEZFACILITY TYPE:
740
ADDRESS:8757 BURTON WAYTELEPHONE:
(310) 278-8323
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY:138CENSUS: 44DATE:
09/12/2025
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Sandy Iraheta - Resident CoordinatorTIME COMPLETED:
03:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
The facility did not report the incident to Licensing.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On September 12, 2025, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial unannounced complaint visit. Sandy Iraheta, Resident Coordinatorr, greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegation mentioned above.

The investigation included interviews, a collection of records, and a tour of the facility. Interviews were conducted with Staff #1 through Staff #3 (S1-S3), Resident #1 (R1) and Witness #1 (W1). The Department reviewed several documents, including the Facility Resident Roster (dated 09/12/25), Facility Personnel Roster (dated 09/11/25), and (R1's) Physicians Report LIC 602A (dated 02/24/25), as well as other pertinent records associated with this complaint.

(Evaluation Report continues LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
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-20250909091421
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: 197602370
VISIT DATE: 09/12/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
INVESTIGATION REVEALED THE FOLLOWING:

Allegation #2: The facility did not report the incident to Licensing.

The complaint alleges that the staff did not report incidents involving Resident #1 (R1) to Community Care Licensing. According to the reports, the facility failed to inform the appropriate authorities about (R1) eloping from the premises and subsequent hospitalization. No further information regarding this situation was provided.

On September 12, 2025, between 10:18 AM and 12:15 PM, the Department interviewed staff members identified as Staff #1 through Staff #3. Three (3) out of the three (3) staff members were able to validate the incidents with Resident #1 (R1) eloping from the facility on September 7 and September 8, 2025. All staff statements were verified through the Facility End of Shift Reports (dated 09/06/25 through 09/08/25). (S3) admitted that the facility has not submitted an Unusual Incident Report (LIC 624) to Community Care Licensing regarding incidents involving (R1). According to the internal Facility End of Shift Reports, Resident #1 (R1) experienced an unwitnessed fall and was hospitalized on September 6, 2025. The following day, (R1) had another incident involving elopement, which resulted in injuries and another hospitalization on September 7, 2025. On September 8, 2025, (R1) eloped once more, prompting the dispatch of law enforcement.

On September 12, 2025, between 12:16 PM and 12:33 PM, the Department interviewed witness identified as the power of attorney to (R1) as Witness #1 (W1). (W1) verified that facility staff notified (W1) of incidents involving (R1) by telephone communication.

On September 12, 2025, the Department verified with the Community Care Licensing Regional Office that there have been no Unusual Incident Reports submitted for (R1).

Based on the information gathered, there is sufficient evidence to support the allegation mentioned above.

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 with Sandy Iraheta, and copies of the reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20250909091421
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: 197602370
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/13/2025
Section Cited
CCR
82711(a)(1)(D)
1
2
3
4
5
6
7
87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing agency...of the occurrence of any of the events... (D) Any incident which threatens the welfare, safety or health of any resident...,or unexplained absence of any resident.
This requirement was not met as evidence by:
1
2
3
4
5
6
7
Licensee agrees that a Plan of Correction will be submitted to CCLD by 09/13/25 with Unusual Incident Reports LIC 624 involving (R1) incidents 09/06/25, 09/07/25 and 09/08/25 to (CCL). POC must be fax to 424-544-1016.
8
9
10
11
12
13
14
Based on LPA interviews conducted and record reviews, the Licensee failed to report incidents involving (R1's)wandering, injuries, or hospitalization. This violation poses an immediate health and safety risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4