198320105-8-7-2026-11-AS-SCIS-DZ527S-20261022170908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320105
Report Date: 08/07/2026
Date Signed: 08/07/2026 04:35:32 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
07/30/2026 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 11-AS-20260730154021

FACILITY NAME:	AVIATION GUEST HOME		FACILITY NUMBER:	198320105
ADMINISTRATOR:	DEMAFELIX, JEHN MARIC		FACILITY TYPE:	740
ADDRESS:	317 S. AVIATION BLVD		TELEPHONE:	(310) 533-1131
CITY:	MANHATTAN BEACH	STATE: CA	ZIP CODE:	90266
CAPACITY:	6	CENSUS: 6	DATE:	08/07/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Irene Sigue Support Staff		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff does not ensure residents are served nutritious meals
Facility is not sufficiently staffed to meet the needs of residents in care
Staff do not ensure resident's basic needs are being met

INVESTIGATION FINDINGS:

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On 08/7/2026, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to investigate and deliver findings for the alleged allegation. LPA identified herself and met with Irene Sigue Support staff who were informed of the purpose of the visit.

The investigation consisted of:

On 8/7/2026 at 8:45 AM, the Department’s Licensing Program Analyst Bernadette Allen toured the facility. The LPA observed two (2) staff members working during the visit, five (5) residents present, and one (1) resident was not at the facility at the time of the visit. The department also conducted interviews with Residents 1–6 (R1–R6), Staff 1–3 (S1–S3), Witness 1 (W1), observations made during the tour, and a review of facility records and medication administration records (MARs).

Continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

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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Control Number 11-AS-20260730154021

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: AVIATION GUEST HOME	FACILITY NUMBER: 198320105
	VISIT DATE: 08/07/2026

NARRATIVE

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At 9:15 AM, T The Department conducted a tour of the facility and observed breakfast being prepared, consisting of cold cereal with blueberries/fruit, a boiled egg, and coffee, juice, and/or water. The Department also observed lunch preparations and asked staff about the menu. Irene confirmed that lunch would consist of marinated pork, white rice, broccoli, and cauliflower. A posted menu was available for review. The facility had a 5-day supply of perishable food and a 7-day supply of non-perishable food, all of which were properly stored and maintained.

At 10:25 AM, The Department conducted a review of six (6) clients’ files, which included admission agreements, needs and services plans, and physician reports. All documents appeared to be current.

At 12:27 PM, the Department conducted interviews with three (3) staff members (S1–S3). Staff member S3 was interviewed by phone. During the interviews, staff were asked whether they ensure residents are served nutritious and balanced meals and 3 out of 3 staff members stated yes. When asked whether residents are provided with alternative meal options, all three staff members also responded yes. Staff confirmed that snacks are available, and the Department observed cookies, a variety of fruit, ice cream, Jell-O, and yogurt during the visit.

Staff were asked whether the facility has sufficient staffing to meet residents’ needs, and 3 out of 3 staff members stated yes. The staff reported that there are typically two (2) to three (3) staff members present at the facility at one time. During the visit, the LPA observed two (2) staff members working and one (1) staff member off the clock in the designated break area. Staffing appeared sufficient to meet residents’ needs at the time of the visit.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260730154021

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: AVIATION GUEST HOME	FACILITY NUMBER: 198320105
	VISIT DATE: 08/07/2026

NARRATIVE

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Staff were also asked whether residents’ basic needs are being met, and 3 out of 3 confirmed yes. Residents are assisted throughout the day with activities of daily living (ADLs), including dressing, grooming, cleaning of residents’ rooms and bathrooms, and meal preparation. During the visit, the Department observed S1 preparing breakfast and lunch consistent with the posted menu. S2 was assisting residents with ADLs. The Department also observed an outside activity director staff person engaging residents in games during the visit.

The Department conducted interviews with three (3) residents: R1, R2, and R5. They were asked whether staff ensure residents are served nutritious meals and three (3) out of six (6) residents stated that the food was “okay” or “eatable,” and that they felt the meals were balanced.

Residents were also asked whether there is sufficient staff to meet their needs. Three (3) out of six (6) residents stated yes, reporting that they receive assistance with their daily needs and that there are always at least two (2) staff members available to help them. The Department attempted to interview R3, but the resident was not available during the visit. R4 was asleep, and R6 was unable to participate in a clear conversation. The Department also interviewed Witness 1 (W1), who stated that residents are provided with nutritious meals, there is enough staff to meet residents’ needs, and that residents’ needs appear to be met by the staff.

Based on interviews, file review and observation during the investigation, the above allegation is found to be Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted where this report was discussed and provided to Bessie Coello- Administrator at the conclusion of the visit with appeal rights.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

LIC9099 (FAS) - (06/04)

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