198203919-5-5-2026-11-AS-UCOL-DU4UCM-20260515152809

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198203919
Report Date: 05/05/2026
Date Signed: 05/05/2026 01:15:27 PM

Substantiated

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
11/04/2025 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20251104083731

FACILITY NAME:	TLC GUEST HOME II		FACILITY NUMBER:	198203919
ADMINISTRATOR:	MUQEET "MD" DAABHOY		FACILITY TYPE:	740
ADDRESS:	28024 CALZADA DR.		TELEPHONE:	(310) 548-0898
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY:	6; 6	CENSUS: 3	DATE:	05/05/2026
		UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Rino Santos - House Manager		TIME COMPLETED:	01:18 PM

ALLEGATION(S):

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Staff do not provide adequate food service

INVESTIGATION FINDINGS:

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On 04/05/25 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent unannounced complaint visit at the facility. California Department of Social Services (CDSS) was met by staff one, Rino Santos - House Manager (S1) and the reason for the visit was explained.
The investigation consisted of the following:
On 11/14/25 CDSS collected documents listed as follows: Increase in rent for three (3) residents (dated 11/03/25), admission agreements for one (1) resident (dated 05/07/25), physician's report for one resident (dated 05/05/25) and internal notes between facility and one resident (dated 11/03/25) (Party A). CDSS interviewed four (4) residents (R1-R4) and three (3) staff (S1-S3). On 05/05/26 CDSS collected further documents.
The investigation revealed the following:

Report continues, please see LIC9099-C.

Substantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

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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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
11/04/2025 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20251104083731

FACILITY NAME:	TLC GUEST HOME II		FACILITY NUMBER:	198203919
ADMINISTRATOR:	MUQEET "MD" DAABHOY		FACILITY TYPE:	740
ADDRESS:	28024 CALZADA DR.		TELEPHONE:	(310) 548-0898
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY:	6; 6	CENSUS: 3	DATE:	05/05/2026
		UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Rino Santos - House Manager		TIME COMPLETED:	01:18 PM

ALLEGATION(S):

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Staff did not provide resident's responsible party with itemization of additional fees charged
Illegal eviction
Staff do not treat resident with dignity and respect

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

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

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 11-AS-20251104083731

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: TLC GUEST HOME II	FACILITY NUMBER: 198203919
	VISIT DATE: 05/05/2026

NARRATIVE

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Interviews revealed that three (3) out of four (4) residents (R2-R4) and all three (3) staff (S1-S3) have denied the allegation has taken place. On 11/14/25 CDSS collected an immediate resolution between party A and the facility (party B), dated 11/03/25. Record reviews have revealed that party B has informed party A of party B's responsibility to care for party A. This document has been signed by both parties. Furthermore, party A has signed the addendum for managed care program participants, dated 05/07/25. This document is an agreement between both parties, which is broken down into five segments, which explains the fee process. Based on record reviews 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.
Regarding the allegation, “Illegal eviction”, it is being alleged that if party A does not agree with it, they can consider it a 60-day eviction notice, from party B. Interviews revealed that all four (4) residents (R1-R4) and all three (3) staff (S1-S3) have denied the allegation has taken place. Record reviews have revealed that party B has informed party A of party B's responsibility to care for party A. This document has been signed by both parties. Furthermore, party A has signed the addendum for managed care program participants, dated 05/07/25. This document is an agreement between both parties, which is broken down into five segments, which explains the fee process. CDSS was not provided any eviction notice. Based on record reviews 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.
Regarding the allegation, “Staff do not treat resident with dignity and respect”, it is being alleged that the staff turn the water off while party A is showering. Interviews have revealed that two (2) out of four (4) residents (R2-R3) and all three (3) staff (S1-S3) have denied the allegation has taken place. Based on 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.

There have been zero (0) deficiencies cited during today's visit.

An exit interview was held with Rino Santos and a copy of this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20251104083731

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: TLC GUEST HOME II	FACILITY NUMBER: 198203919
	VISIT DATE: 05/05/2026

NARRATIVE

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Regarding the allegation, “Staff do not provide adequate food service”, it is being alleged that party B never serve fresh food. Record reviews revealed that food menu indicates a fresh food is provided daily. Interviews revealed that three (3) out of four (4) residents (R1, R2, R4) have agreed the allegation has taken place. On 11/14/25 R1 stated, "They don’t cook everyday. They cook for themselves every day, but it’s not for us. They provide us that later. Four (4) or five (5) days later.". On 11/14/25 S3 has stated, "For residents I will cook salmon and vegetables. The one I'm cooking now is for the staff.", which indicates that fresh food is not always provided to residents in care. Based on record reviews and interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title twenty-two (22), Division six (6) is being cited on the attached LIC 9099-D.

There has been one (1) deficiency cited during today's visit. Please see LIC9099-D.

An exit interview was held with Rino Santos (S1) and a Plan of Corrections (POC) has been developed. A copy of the facilities' appeal rights and this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20251104083731

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: TLC GUEST HOME II	FACILITY NUMBER: 198203919
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/05/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/12/2026 Section Cited CCR 87555(b)(5)	1 2 3 4 5 6 7	87555(b)(5) General Food Service Requirements (b) The following food service requirements shall apply: (5) Meals shall consist of an appropriate variety of foods and shall be planned with consideration for cultural and religious background and food habits of residents.	1 2 3 4 5 6 7	CDSS and S1 have agreed that the facility will update their meal plan, with input from residents in care; on, or before, the POC due date. Facility will email updates to LPA at MARIO.LEON@DSS.CA.GOV
	8 9 10 11 12 13 14	This has not been met as evidenced by: Based on record reviews and interviews conducted the licensee did not ensure that an appropriate variety of foods has been provided to three (3) residents, #1, #2, & #4 which poses a potential health risk to residents in care	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

LIC9099 (FAS) - (06/04)

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