197608604-3-1-2025-28-AS-TVAO-DEFTEG-20250304133952

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608604
Report Date: 03/01/2025
Date Signed: 03/01/2025 08:48:32 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
02/26/2025 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250226130647

FACILITY NAME:	PROMISE ASSISTED LIVING, LLC.		FACILITY NUMBER:	197608604
ADMINISTRATOR:	GREGORY Z. RESTUM		FACILITY TYPE:	740
ADDRESS:	1231 SOUTH ALVARADO STREET		TELEPHONE:	(310) 205-2591
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90006
CAPACITY:	22	CENSUS: 22	DATE:	03/01/2025
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Supervisor Roxana Aparicio		TIME COMPLETED:	09:00 AM

ALLEGATION(S):

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Licensee is preventing resident from seeing a doctor of their choice
Staff are not adequately trained
Staff did not keep the facility free of cockroaches
Staff did not keep the facility free of bedbugs
Staff exposed residents to chemicals that are hazardou

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Supervisor Roxana Aparicio and explained the purpose of the visit.

The investigation consisted of the following: During the initial visit conducted on 02/27/2025, LPA interviewed Staff #1 - Staff #5, Resident #1- Resident #5.LPA obtained copies of the following documents: Staff roster, Resident roster, CPR/FIRST AID for S1-S5, R1’s LIC 601 Identification and emergency information, appraisal information, and Physicians reports. LPA toured the facility and obtained copies of invoices for rodent and pest services. During today’s visit LPA Gutierrez delivered findings.

SEE 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Christian Gutierrez	TELEPHONE: 323-981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2025

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-20250226130647

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: PROMISE ASSISTED LIVING, LLC.	FACILITY NUMBER: 197608604
	VISIT DATE: 03/01/2025

NARRATIVE

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In regard to the allegation “Licensee is preventing resident from seeing a doctor of their choice”, it is alleged that staff is forcing residents to be seen by the facility house doctor. During interviews with staff five (5) out of five (5) staff stated that all residents had a choice of to what doctor residents want to see. S2 states they have residents that see their own doctors. During interviews with residents four (4) out of five (5) residents stated they can pick their own doctors. R1 stated he/she has their own doctor and does not see house doctor.

In regard to the allegation “Staff are not adequately trained”, It is alleged that a resident was choking, and staff did not know how to perform the Heimlich maneuver. During interviews with staff five (5) out of five (5) staff stated that all employees are CPR/FIRST AID trained and that they have never witnessed a resident preforming Heimlich on another resident. LPA obtained copies of CPR training for five (5) staff members. During interviews with residents four (4) out of five (5) residents felt staff is properly trained.

In regard to the allegation “Staff did not keep the facility free of cockroaches and Staff did not keep the facility free of bedbugs”, it is alleged that facility has cockroaches and bedbugs. During interviews with staff four (4) out of five (5) stated they are aware of the bed bug/cockroach problem, but the facility has been addressing the issues with rodent and pest services monthly for the last six months. LPA obtained all invoices for last six months. During interviews with residents five (5) out of five (5) all confirmed that they spray the facility every month.

In regard to the allegation “Staff exposed residents to chemicals that are hazardous”, it is alleged that when the exterminator comes to spray residents are moved to another room that had just been sprayed. During interviews with staff five (5) out of five (5) stated that residents need to go outside on the patio area or in the dining room that was treated hours before. Staff stated some residents are mad because they want to go back to their bedrooms right away. During interviews with residents three (3) out of five (5) residents don’t feel that that they are being exposed to hazardous chemicals. R2 stated that he/she had only been at facility for a month and was unaware of spraying. R1 stated that it made no sense to not let them back in to their bedrooms.

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 given to Supervisor Roxana Aparicio.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Christian Gutierrez	TELEPHONE: 323-981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2025

LIC9099 (FAS) - (06/04)

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