197606651-5-20-2025-28-AS-DSIS-DHQNYM-20250617105257

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606651
Report Date: 05/20/2025
Date Signed: 05/20/2025 11:49:48 AM

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
05/19/2025 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250519093602

FACILITY NAME:	LAKEWOOD GARDENS		FACILITY NUMBER:	197606651
ADMINISTRATOR:	MARIE JEENE R DE CASTRO		FACILITY TYPE:	740
ADDRESS:	12055 S. LAKEWOOD BLVD.		TELEPHONE:	(562) 869-4038
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	150	CENSUS: 88	DATE:	05/20/2025
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Jeene De Castro Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not address a resident's change in medical condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced complaint investigation regarding the above allegations. LPA was met by Rita Rena Assistant Administrator and explained the purpose of the visit. Administrator Jeene De Castro arrived shortly.

The investigation consisted of the following: LPA Gutierrez requested and obtained copies of staff roster, resident roster, R1’s identification and emergency information, physicians report, body assessment documentation, SIR reports, caretakers notes, and city of Downey police Officer business card. LPA conducted interviews with Administrator, staff 1- staff 2 (S1-S2), and resident’s 1 – 8 (R1-R8).

SEE 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Christian Gutierrez	TELEPHONE: 323-981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250519093602

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: LAKEWOOD GARDENS	FACILITY NUMBER: 197606651
	VISIT DATE: 05/20/2025

NARRATIVE

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In regard to the allegation “Staff did not address a resident's change in medical condition “, it is alleged that R1 arrived at hospital and had suffered a fracture from a fall. During interviews with Administrator, and staff three (3) out of three (3) stated that R1 had not fallen to their knowledge. Caregiver in the early morning had noticed swelling and redness and immediately acted by giving doctors order pain medication and calling for ambulance for pick up. Administrator stated that when asked R1 stated he/she had not fallen. During interviews with residents five (5) out of six (6) stated that staff seek medical attention if needed. R1 stated that he/she fell and that they did not tell staff. During investigation it was revealed that RP did not suspect abuse or neglect with resident however they were told that any fall should be reported.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was proved.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Christian Gutierrez	TELEPHONE: 323-981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

LIC9099 (FAS) - (06/04)

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