197608376-2-19-2026-11-AS-EMAZ-DSS2AT-20260402171403

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608376
Report Date: 02/19/2026
Date Signed: 02/19/2026 05:11:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/13/2026 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20260213150937

FACILITY NAME:	REDONDO BEACH ELDERLY HOME		FACILITY NUMBER:	197608376
ADMINISTRATOR:	JEHN MARIC DEMAFELIX		FACILITY TYPE:	740
ADDRESS:	18312 MANSEL AVENUE		TELEPHONE:	(310) 371-7193
CITY:	REDONDO BEACH	STATE: CA	ZIP CODE:	90278
CAPACITY:	12	CENSUS: 9	DATE:	02/19/2026
		UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	Jehn 'JM' Maric Demafelix		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Client sustained an injury (bump to the head) due to staff neglect or physical abuse

INVESTIGATION FINDINGS:

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On 02/19/2026, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Complaint Visit to the facility listed above. LPA met with Administrator, Jehn 'JM' Maric Demafelix, and the purpose of today’s visit was explained. LPA was granted entry into the facility.

The investigation consisted of the following:
During today’s visit the department inspected the facility, interviewed Staff S1-S5, interviewed Residents R2-R5, interviewed resident’s Responsible Party W1-W3, and received documents pertinent to the investigation. The following documents were received and reviewed Staff Roster, Resident Roster, Staff Relias Transcript, Staff's Statement Acknowledging Requirement to Report Suspected Abuse to Dependent Adults or Elders, R1’s Medical Assessment dated 01/28/2026, Preplacement Appraisal Information dated 01/29/2026, R1’s Personal Rights dated 01/30/2026, and Admission Agreement dated 01/30/2026.
The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026

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 11-AS-20260213150937

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: REDONDO BEACH ELDERLY HOME	FACILITY NUMBER: 197608376
	VISIT DATE: 02/19/2026

NARRATIVE

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Allegation: Client sustained an injury (bump on the head) due to staff neglect or physical abuse
The allegation alleges that a resident had a bump and bruise to the right side of the forehead and staff were unable to explain how the resident sustained the injury.

During the facility inspection LPA was looking to observe or identify any signs of neglect, abuse, or other immediate health and safety threats. LPA observed staff assisting residents from breakfast to either their room or common area and cleaning. LPA observed staff assisting residents with activities of daily living (ADL’s) such as toileting, changing, bathing, grooming, and transferring. Additionally, LPA observed staff going into residents’ rooms to see if they required assistance and asking how they are doing and feeling.

During record review, LPA received and reviewed staff’s Relias Transcript that indicate staff have received training regarding Overseeing, Reporting, and Documenting, Recognizing a Change in Condition, and How to Recognize and Report Skin Condition. LPA received and reviewed R1’s Personal Right of Residents (LIC 613C) dated and signed by R1's Responsible Party on 01/30/2026 that states resident’s have the right “to be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse.” LPA observed Residents Personal Rights posted on a board in the common area.

During interviews with Resident’s R2-R5 were asked if they have observed or have any concerns regarding neglect from the staff, four (4) out of four (4) stated they have not observed nor do they have any concerns regarding neglect.

During interviews with Staff S1-S5 were asked were asked whether residents are neglected, five (5) out of five (5) stated residents in care are not neglected. Additionally, five (5) out of five (5) stated they have not seen a staff neglect or physically abuse a resident.
During interviews with resident’s Responsible Party W1-W3, were asked if they have any concerns regarding neglect, two (2) out of three (3) stated they do not have any concerns regarding neglect.

During the course of the investigation, LPA was unable to find evidence to support the allegation(s). Although the allegation(s) may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) is/are unsubstantiated.

During today’s visit, LPA did not observe or cite any deficiencies.

An exit interview was conducted with Administrator, Jehn 'JM' Maric Demafelix, and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026

LIC9099 (FAS) - (06/04)

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