197803745-5-12-2025-28-AS-RORN-DGPRW5-20250515132233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197803745
Report Date: 05/12/2025
Date Signed: 05/12/2025 01:04:13 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/06/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250506141030

FACILITY NAME:	COUNTRY INN OF DOWNEY		FACILITY NUMBER:	197803745
ADMINISTRATOR:	ANA YESENIA GIRON		FACILITY TYPE:	740
ADDRESS:	11111 MYRTLE ST.		TELEPHONE:	(562) 869-2401
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY:	150	CENSUS: 79	DATE:	05/12/2025
		UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Erika Becerra - Assistant Administrator/Med-Tech		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility did not maintain a comfortable temperature for residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegation. LPA met with Patricia Hernandez and explained the purpose of today's visit, shortly after Assistant Administrator/Med-Tech Erika Becerra arrived to assist with visit.

The investigation consisted of the following:

LPA obtained copies of staff & resident rosters, toured both 1st and second floors of the facility and toured 7 resident rooms, LPA observed thermostats on 1st and 2nd floors and interviewed Staff (S1-S4) and 8 Residents (R1-R8).

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

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-20250506141030

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: COUNTRY INN OF DOWNEY	FACILITY NUMBER: 197803745
	VISIT DATE: 05/12/2025

NARRATIVE

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The investigation revealed the following:
Allegation: Facility did not maintain a comfortable temperature for residents.
It is alleged that residents room temperatures are maintained at an uncomfortable temperature of 85 degrees F. LPA toured facility both upstairs and downstairs, during tour LPA entered 6 resident rooms (Room #’s 1, 6, 10, 36, 43, 44, 53), each room appeared to be within a cool temperature. Each room that was toured had widows that open/closed properly, vents in rooms were on and were producing cool/cold air. Rooms 1 and 43 had operable fans that were on. LPA was informed that there are multiple air conditioning units in the facility that control different areas/rooms, each unit has a thermostat that controls cooling/heating system for approximately 10 rooms each. LPA observed 2 downstairs thermostats and 3 upstairs thermostats and each had readings that were within the required range of 68-85 degrees F, readings were measured between 77-79 degrees F, LPA measured the temperature with personal thermostat in room #1 and the reading reached 78.8 degrees. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation and stated that although some rooms may get warm due to residents using personal portable heaters, they ensure that rooms temperatures are at a comfortable setting. LPA interviewed 8 residents and 8 out of 8 residents denied the above allegation, some stated that although their rooms can be too cold they are provided with a portable heater for their room, R5 stated it does get warm in their room but they have a fan to keep them cool.

Based on statements and interviews conducted with staff/residents, tour of facility and LPA's observations, there was not enough supportive evidence to concur with the reported allegation. 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. Exit interview held, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

LIC9099 (FAS) - (06/04)

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