198200855-7-27-2026-11-AS-PMAA-DXCPL2-20260827112403

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198200855
Report Date: 07/27/2026
Date Signed: 07/27/2026 01:08:28 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2026 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260714093225

FACILITY NAME:	HARBOR TERRACE RETIREMENT CENTER OF SAN PEDRO, LLC		FACILITY NUMBER:	198200855
ADMINISTRATOR:	HOLLY RICE		FACILITY TYPE:	740
ADDRESS:	435 WEST 8TH STREET		TELEPHONE:	(310) 547-0090
CITY:	SAN PEDRO	STATE: CA	ZIP CODE:	90731
CAPACITY:	202; 202	CENSUS: 70	DATE:	07/27/2026
		UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Holly Rice		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff did not ensure resident personal property was kept safely secured.
Staff does not ensure resident is provided with toileting assistance.
Staff does not provide resident with adequate assistance when standing.

INVESTIGATION FINDINGS:

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** This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 07/22/26. **On 07/27/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint investigation visit for the allegations listed above. LPA met with Administrator Holly Rice, explained the purpose of the visit, and was granted entry to the facility.

On 07/22/26, the department conducted an unannounced complaint visit to investigate the allegations listed above. The department met with Assistant Administrator, Sandra Marquez, and the purpose of the visit was explained. The department was granted entry to the facility.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026

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

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 11-AS-20260714093225

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HARBOR TERRACE RETIREMENT CENTER OF SAN PEDRO, LLC	FACILITY NUMBER: 198200855
	VISIT DATE: 07/27/2026

NARRATIVE

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The investigation consisted of the following: The department obtained the following documents: staff roster, resident roster, and an Unusual Incident/Injury Report (SIR) dated: 07/13/26. The department conducted a review of resident #1’s (R1’s) file and obtained copies of the following documents: Identification and Emergency Information, Care Services form, Physician’s Report, Personal Rights, Assisted Living Residency Agreement, and Appraisal Needs and Services Plan. The department conducted interviews with staff #1-#5 (S1-S5) and R1-R8. Additionally, the department conducted a tour of the facility. On 07/27/26, the department conducted an interview with R1.

The investigation revealed the following:

Allegation: Staff did not ensure resident personal property was kept safely secured. It is being alleged that $200 went missing from a residents wallet. It is also being alleged that this is the second time money has been taken from this resident. On 07/22/26, the department conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff denied the allegation. 5 out of 5 staff said they treat residents with dignity and respect. An interview with S1 revealed that R1's family member reported that $180 was missing from R1 on 07/13/26. S1 stated that they, along with the facility's Executive Director, went to R1's room to assist in searching for the missing money; however, the money was not located. S1 further stated that the family was advised of options to help safeguard R1's money, including installing a camera in R1's room and/or completing an LIC 405 to have facility staff secure and maintain and safekeep R1's funds.

On 07/22/26, and 07/27/26, the department conducted interviews with R1-R8. Of those interviewed, 7 out of 8 residents could not corroborate the allegation. 7 out of 8 residents stated they had never experienced any incidents involving missing money or personal belongings. An interview with R1 revealed that they've experienced money missing on two separate occasions. R1 stated that they were unsure who took the money and could not confirm whether a staff member was responsible.

On 07/22/26, the department reviewed an Unusual Incident/Injury Report dated 07/13/26. The report documented that on 07/13/26, R1's family member contacted the facility to report that money was missing from R1. According to the report, S1, R1, and the facility's Executive Director, Holly Rice, spoke with R1's family member via speakerphone to discuss the details of the incident. The report stated that R1 had withdrawn $200 in cash on 07/08/26 and discovered on 07/13/26 that $180 was missing.

Continued on LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260714093225

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HARBOR TERRACE RETIREMENT CENTER OF SAN PEDRO, LLC	FACILITY NUMBER: 198200855
	VISIT DATE: 07/27/2026

NARRATIVE

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The report further stated that S1 and Executive Director Holly Rice assisted R1 in searching R1's personal belongings, including the wallet, walker, clothing, pockets, and apartment; however, the missing cash was not located. The report documented that staff notified R1's family member that the cash could not be found and recommended that R1 maintain a Record of Resident's Safeguarded Cash Resources (LIC 405) in the administrative office to help safeguard R1's funds. The report also indicated that the incident was documented on the facility's theft and loss report.

Based on observation, records reviewed, and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been unsubstantiated.

Allegation: Staff does not ensure resident is provided with toileting assistance. It is being alleged that a staff member refuses to take a resident to the bathroom and instructs the resident to urinate in their diaper instead. On 07/22/26, the department conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff denied the allegation. 5 out of 5 staff said they treat residents with dignity and respect.

On 07/22/26, and 07/27/26, the department conducted interviews with R1-R8. Of those interviewed, 7 out of 8 residents could not corroborate the allegation. 3 out of 8 residents said staff assist them with their toileting needs, while 5 out of 7 residents said they do not require assistance with toileting. 8 out of 8 residents said they are satisfied with the service being provided to them.

Continued on LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260714093225

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HARBOR TERRACE RETIREMENT CENTER OF SAN PEDRO, LLC	FACILITY NUMBER: 198200855
	VISIT DATE: 07/27/2026

NARRATIVE

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Allegation: Staff does not provide resident with adequate assistance when standing. It is being alleged that staff will poke at the resident rather than assist them in getting up. On 07/22/26, the department conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff denied the allegation. 5 out of 5 staff said they treat residents with dignity and respect.

On 07/22/26, and 07/27/26, the department conducted interviews with R1-R8. Of those interviewed, 7 out of 8 residents could not corroborate the allegation. 8 out of 8 residents stated that staff treat them with dignity and respect.

On 07/22/26, the department conducted a tour of the facility and observed staff interacting with residents during the lunch hour. Staff were observed to be patient, attentive, and respectful in their interactions with residents.

No deficiencies were cited during today's visit.

An exit interview was conducted, and a copy of this report was provided to Holly Rice.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2026

LIC9099 (FAS) - (06/04)

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