197802563-3-23-2026-28-AS-FFIS-DSJV8S-20260326161314

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197802563
Report Date: 03/23/2026
Date Signed: 03/23/2026 02:25:07 PM

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
03/17/2026 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260317095152

FACILITY NAME:	EL DESCANSO RETIREMENT HOME		FACILITY NUMBER:	197802563
ADMINISTRATOR:	BOUSHERI, CLEMENCIA		FACILITY TYPE:	740
ADDRESS:	21020 E. CIENEGA AVENUE		TELEPHONE:	(626) 967-2868
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	15	CENSUS: 15	DATE:	03/23/2026
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Administrator, Clememcia Bousheri		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Facility is operating beyond the limits of the licensed capacity
Facility is operating with insufficient staffing

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vaid conducted an initial visit and was met by facility manager-Escarling Godoyvega, LPA Vaid and manager Godoyvega toured the facility and did not observe any health and safety concerns. Administrator Clemencia Bousheri was notified and arrived shortly after, and the reason for the visit was discussed.

LPA Vaid collect the following document: Staff roster dated 02/05/2026 and resident roster dated 02/10/2026. LPA took head count of residents in care, LPA Vaid counted number of beds in the facility. LPA interviewed residents and staff.

Regarding the allegation: Facility is operating beyond the limits of the licensed capacity. It is alleged that the El Descanso Retirement Home is operating beyond its’ 15 persons’ capacity by allowing more residents into the facility than the capacity allows.
CONTINUED ON 9099C............

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026

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 28-AS-20260317095152

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: EL DESCANSO RETIREMENT HOME	FACILITY NUMBER: 197802563
	VISIT DATE: 03/23/2026

NARRATIVE

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Six of six staff deny this allegation, the facility capacity is fifteen residents, and (15) residents currently reside in the facility. Five of five residents could not corroborate this allegation; residents’ do not know the business operations of the facility. Residents stated not knowing the number of residents in care and that the is staff adequately able to provide assistance to all the residents with their physical needs. Based on LPA observations; residents physical count and number of beds, record review and interviews. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: Facility is operating with insufficient staffing. It is alleged that the facility is improperly staffed, particularly during the evening and the nighttime. Six of six staff deny this allegation, according to the staff roster facility has sufficient staff to assist residents and to meet the residents needs and services. Four to five (4-5) staff are scheduled in the AM shift: 5AM- 1PM, four (4) staff are scheduled for PM shift 1pm to 9PM and one (1) staff during NOC shift (9pm- 5am). According to Administrator staff will work past regular scheduled shifts to assist with residents when required. Four of five residents stated the facility has adequate staff and residents are assisted with their daily needs and services. One of five residents stated facility could hire more staff, but is happy with the current staff persons. Based on LPA observations of residents’ rooms and residents’ bedding, and records review. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

A copy of this investigation complaint report was provided to Administrator Clememcia Bousheri.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026

LIC9099 (FAS) - (06/04)

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