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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204972
Report Date: 12/18/2024
Date Signed: 12/18/2024 02:18:34 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
12/16/2024 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20241216095515
FACILITY NAME:ROSECRANS VILLA RESIDENTIAL CAREFACILITY NUMBER:
198204972
ADMINISTRATOR:SANDRA LOPEZFACILITY TYPE:
740
ADDRESS:14110 CORDARY AVENUETELEPHONE:
(310) 675-9163
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:135CENSUS: 112DATE:
12/18/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator - Sandra LopezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff contaminated residents' food
Staff speak inappropriately to residents
Staff threatened to evict resident
INVESTIGATION FINDINGS:
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On 12/18/2024, the Department of Social Services (DSS) - Community Care Licensing Division (CCLD) staff conducted an unannounced complaint visit at this facility. CCLD staff was greeted by Administrator, Sandra Lopez.

The investigation consisted of the following:
The department interviewed 5 staff and 10 residents, toured the kitchen, reviewed facility records and Resident 1’s (R1) records.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
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 2
Control Number 11-AS-20241216095515
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: ROSECRANS VILLA RESIDENTIAL CARE
FACILITY NUMBER: 198204972
VISIT DATE: 12/18/2024
NARRATIVE
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The investigation revealed the following:

Regarding the allegation “Staff contaminated residents’ food”, it is being alleged that the kitchen staff are contaminating the facility food with feces, fentanyl, and drugs. Interviews conducted revealed the following: 8 out of 10 residents denied the allegation and 5 out of 5 staff denied the allegation. The departments observations revealed the following: the department toured the kitchen and did not observe feces, fentanyl, or drugs. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

Regarding the allegation “Staff speak inappropriately to residents”, it is being alleged that staff are mean to residents in care. Interviews conducted revealed the following: 9 out of 10 residents denied the allegation and 5 out of 5 staff denied the allegation. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

Regarding the allegation “Staff threatened to evict resident”, it is being alleged that the director told R1 that they were going to evict them. Interviews conducted revealed the following: R1 does not know if the facility is trying to evict them; The Administrator indicated that the facility has not given R1 an eviction notice nor warnings. Records reviewed of R1 revealed the following: there are no eviction notices nor warnings for R1. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

No citations were issued.

An exit interview was conducted, and a copy of this report was left with the Administrator.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2