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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204079
Report Date: 05/23/2025
Date Signed: 05/23/2025 04:28:36 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/16/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20250516095343
FACILITY NAME:SPRING SENIOR ASSISTED LIVINGFACILITY NUMBER:
198204079
ADMINISTRATOR:MONNIECE BOATWRIGHTFACILITY TYPE:
740
ADDRESS:20900 EARL STREETTELEPHONE:
(310) 370-3594
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY:51CENSUS: 31DATE:
05/23/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Wellness Director, Amber LollarTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff are mismanaging resident's medication
Staff did not prevent resident from having pests in their room
Staff are inappropriately sharing resident's personal information
INVESTIGATION FINDINGS:
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On 5/23/2024 at around 10:20 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced complaint investigation visit regarding the allegations listed above. LPA met with Wellness Director, Amber Lollar and the purpose of the visit was explained. LPA was granted entry to the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
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 5
Control Number 11-AS-20250516095343
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SPRING SENIOR ASSISTED LIVING
FACILITY NUMBER: 198204079
VISIT DATE: 05/23/2025
NARRATIVE
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Investigation consisted of the following:

On 5/23/2025, a facility tour was conducted, interviews were conducted, and records were reviewed. The facility tour consisted of 5 resident bedrooms. Interviews conducted consisted of 5 staff interviews [Staff 1 (S1) to Staff 5 (S5) were interviewed], 2 informal staff interviews [Staff 6 (S6) to Staff 7 (S7) were interviewed] and 5 resident interviews [Resident 1 (R1) to Resident 5 (R5) were interviewed]. Resident 1’s records were reviewed which consisted of Admission Agreement dated 4/30/2025, Physicians Report dated 5/1/2025, Identification and Emergency Information, Physician’s Report dated 5/1/2025, Medication Administration Record (MAR) for the month of May 2025, Medical documentation and other pertinent documents. Facility records reviewed consisted of Employee roster dated 4/21/2025, Resident Roster dated 5/12/2025, and Fumigation Records from 1/20/2025 to 5/16/2025.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20250516095343
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SPRING SENIOR ASSISTED LIVING
FACILITY NUMBER: 198204079
VISIT DATE: 05/23/2025
NARRATIVE
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Investigation revealed the following:

Allegation: “Staff are mismanaging resident’s medication”, it is being alleged that staff are not ordering R1’s medication and that is why R1 is not receiving their medication. Resident 1’s medical records reviewed revealed the following: The facility attempted to order medication for R1 on 5/6/2025. Interviews conducted with R1 and the Wellness Director, Amber Lollar confirmed that R1 required a follow-up medical appointment for them to receive an approved medication prescription by their physician. Furthermore, R1’s Prescription Order Summary Report dated 5/12/2025 and MAR for the month of May 2025 indicate that R1 has received their medication as prescribed. Additionally, R1 confirmed that they have not requested additional medical equipment that they require from their physician. Based on records reviewed, interviews conducted, and observations this allegation is unsubstantiated. 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.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20250516095343
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SPRING SENIOR ASSISTED LIVING
FACILITY NUMBER: 198204079
VISIT DATE: 05/23/2025
NARRATIVE
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Allegation: “Staff did not prevent resident from having pests in their room”, it is being alleged that there are ants in residents’ rooms and the facility does not address the issue. Interviews conducted with R1 to R5 revealed the following: 1 out of 5 residents agreed with the allegation. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation. Fumigation Records from 1/20/2025 to 5/16/2025 revealed the following: the facility receives fumigation services once a month. Observations reveled the following: on 5/23/2025 five resident rooms were toured, and no ants were observed. Based on records reviewed, interviews conducted, and observations this allegation is unsubstantiated. 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.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20250516095343
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SPRING SENIOR ASSISTED LIVING
FACILITY NUMBER: 198204079
VISIT DATE: 05/23/2025
NARRATIVE
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Allegation: “Staff are inappropriately sharing resident's personal information.” Interviews conducted with R1 to R5 revealed the following: 1 out of 5 residents agreed with the allegation. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation. Based on interviews conducted this allegation is unsubstantiated. 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.

No deficiencies were cited.

An exit interview was conducted, and a copy of this report was left with the Wellness Director, Amber Lollar.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5