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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320095
Report Date: 04/30/2026
Date Signed: 04/30/2026 04:32:02 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, 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
04/28/2026 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20260428112843
FACILITY NAME:HAWTHORNE TERRACE CARE HOME, LLCFACILITY NUMBER:
198320095
ADMINISTRATOR:HAUF, MARYFACILITY TYPE:
740
ADDRESS:4760 W 123RD STTELEPHONE:
(201) 562-8622
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 10DATE:
04/30/2026
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Administrator - Zuo Fen HaufTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff do not prevent resident from not treating residents with dignity and respect.
INVESTIGATION FINDINGS:
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On 04/30/2026, Licensing Program Analyst (LPA) Socorro Leandro initiated a complaint investigation regarding the allegation listed above. LPA met with the Administrator, Zuo Fen Hauf, and the purpose of the visit was explained. The LPA was allowed entry to the facility.

The investigation consisted of the following:

A tour of the facility was conducted, interviews were conducted, and records were gathered. Interviews consisted of Resident 1 (R1) to Resident 9 (R9) and Staff 1 (S1) to Staff 4 (S4). Facility records gathered consisted of Register of Facility Residents dated 01/19/2025; Personnel Report dated 04/10/2026; and staff trainings. R1’s records were gathered which consisted of the California Assisted Living Waiver (ALW) Program Individual Service Plan (ISP) dated 11/18/2022; Physician’s Report dated 01/06/2023; Preplacement Appraisal Information dated 03/31/2023; and Medical Documents dated 03/11/2026 to 04/22/2026.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
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 3
Control Number 11-AS-20260428112843
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: HAWTHORNE TERRACE CARE HOME, LLC
FACILITY NUMBER: 198320095
VISIT DATE: 04/30/2026
NARRATIVE
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The investigation revealed the following:

Allegation: “Staff do not prevent resident from not treating residents with dignity and respect.” Interviews conducted with R1 to R9 revealed the following: 5 out of 9 residents agree with the allegation; 3 out of 9 residents denied the allegation; 1 out of 9 residents indicated that they have heard a resident use profanity but were unsure if staff intervened (because they were in their room and could not see the incidents). Interviews conducted with S1 to S4 revealed the following: 3 out of 4 staff indicated that they ignore R1 when they are verbally aggressive toward other residents; 2 out of 3 staff indicated that they do attempt to de-escalate R1 when they are verbally aggressive toward other residents by talking to R1 in a calm voice and telling other residents to go to their rooms; 1 out of 4 staff indicated that they have not witnessed residents being verbally aggressive toward other residents. The Administrator indicated that they have not trained staff on R1’s care plan for de-escalation. R1’s California Assisted Living Waiver (ALW) Program Individual Service Plan (ISP) dated 11/18/2022 revealed the following: “Socialization: Participant at risk for episodes of verbal aggression towards other residents and staff…Interventions/Plan: RCFE staff to use thoughtful and careful redirecting as needed to diffuse aggressive/inappropriate social behavior.” R1’s Medical Documents dated 03/11/2026 revealed the following: “Chief complaint:..Concerns: responds to internal stimuli (talks to self), verbal aggression/profanity toward self/staff/residents…” R1’s Medical Documents dated 04/22/2026 revealed the following: it indicated that R1’s “baseline” remains the same. Observations on 04/30/2026 revealed the following: R1 used profanity in a very loud voice; according to S1 and S4 R1 was in their room talking to themselves. Staff trainings revealed the following: staff have been trained on resident rights and behavioral expression management. Based on observations, interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Administrator, Zuo Fen Hauf.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20260428112843
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: HAWTHORNE TERRACE CARE HOME, LLC
FACILITY NUMBER: 198320095
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/14/2026
Section Cited
CCR
87468.1(a)(1)
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Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.

This requirement is not met as evidenced by:
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The Administrator has agreed to train staff on resident personal rights, R1’s care plan and create de-escalation methods for R1. The Administrator will email staff trainings to Socorro.Leandro@dss.ca.gov.
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Based on observations, interviews, and records reviewed the licensee did not comply with the section cited above not by residents not being treated with dignity by other residents in the facility.
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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: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
LIC9099 (FAS) - (06/04)
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