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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320304
Report Date: 03/04/2026
Date Signed: 03/04/2026 12:26:21 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
02/20/2026 and conducted by Evaluator Felisa Shirley
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20260220083424
FACILITY NAME:KINAH MAE HOME LLCFACILITY NUMBER:
198320304
ADMINISTRATOR:WHITFORD, WALKIRIAFACILITY TYPE:
740
ADDRESS:1420 W. 186TH ST.TELEPHONE:
(310) 720-7080
CITY:GARDENASTATE: CAZIP CODE:
90248
CAPACITY:6CENSUS: 5DATE:
03/04/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Renette DeLaCruz, AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff do not answer phone calls in a timely manner.
Staff are not ensuring to meet the residents’ needs in a timely manner.
Staff speak inappropriately to residents in care.
Staff do not ensure that residents are provided with activities.
INVESTIGATION FINDINGS:
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On 3/4/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by the Administrator, Renette De La Cruz and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility.

The investigation consisted of the following:
On 2/25/26 LPA Shirley reviewed copies of the following records: Staff and Resident Roster, Identification and Emergency Information form, Physicians Report and an Incident report. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff-3 (S1 – S3), and Resident -1 – Resident - 5(R1-R5).

The investigation revealed the following:

Con'd on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
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-20260220083424
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: KINAH MAE HOME LLC
FACILITY NUMBER: 198320304
VISIT DATE: 03/04/2026
NARRATIVE
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Allegation: Staff do not answer phone calls in a timely manner.

It is being reported that calls go unanswered to the facility during the evening hours despite numerous attempts. During the interview with the Administrator, 2/25/26, she indicated that staff promptly handles all incoming calls. Per interview, 2/25/26, S3 stated if the direct lines to the facility go unanswered, families sometimes utilize personal contact numbers of the staff, and staff return calls at their earliest convenience. Per S3, if they are working with a client, they can’t return calls until they are done with the client.

LPA interviewed staff 1 – staff 3 (S-1 – S-3). Of those interviewed 3 out of 3 denied the allegation. LPA interviewed resident 1 – resident 5 (R1 – R5). Of those who interviewed 3 out of 5 denied the allegation. Two neither confirmed nor denied the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff do not answer phone calls in a timely manner,” therefore, the allegation is unsubstantiated.

Allegation: Staff are not ensuring to meet the residents’ needs in a timely manner.

It is being reported that a resident needed assistance in the facility and the staff weren’t responding when he pressed the call bell. Per interview, 2/25/26, S3 stated that once he’s completed working with the current resident, he checks in with the other residents to offer support. Per interview, 2/25/26, R4 stated at times the staff informs her they are working with another resident. I understand that I’m not the only one that needs assistance, and I’m happy to wait. I don’t have to wait too long.

LPA interviewed staff 1 – staff 3 (S-1 – S-3). Of those interviewed 3 out of 3 denied the allegation. LPA interviewed resident 1 – resident 5 (R1 – R5). Of those who interviewed 4 out of 5 denied the allegation. One resident confirmed the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff are not ensuring to meet the residents’ needs in a timely manner,” therefore, the allegation is unsubstantiated.

Con'd on 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20260220083424
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: KINAH MAE HOME LLC
FACILITY NUMBER: 198320304
VISIT DATE: 03/04/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
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15
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Allegation: Staff speak inappropriately to residents in care.

It is being reported that staff are using disrespectful and inappropriate language to the residents. Based on interviews, 2/25/26, with staff and residents, there is no evidence of inappropriate verbal communication.

LPA interviewed staff 1 – staff 3 (S-1 – S-3). Of those interviewed 3 out of 3 denied the allegation. LPA interviewed resident 1 – resident 5 (R1 – R5). Of those who interviewed 4 out of 5 denied the allegation. One resident confirmed the allegation

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff speak inappropriately to residents in care,” therefore, the allegation is unsubstantiated.

Allegation: Staff do not ensure that residents are provided with activities.

It is being reported that the staff does not provide residents with activities and keeps them in their rooms for most of the day. During each of my unannounced visits as a Licensing Program Analyst, I have observed residents spending their time in the main living area. Today, 3/4/26, when LPA Shirley arrived to this facility, I observed and heard R4 and her visitor singing a gospel song being sung on the music channel that they were watching. LPA Shirley observed, R3 engaged on her phone enjoying mobile gaming. On 2/25/26, LPA Shirley observed videos and pictures of the residents doing chair exercises, pedaling and walking in the backyard. Per interview with R4, 2/25/26, she doesn’t participate in the exercises anymore as she has grown tired of doing them.

LPA interviewed staff 1 – staff 3(S-1 – S-3). Of those interviewed 3 out of 3 denied the allegation. LPA interviewed resident 1 – resident 5 (R1 – R5). Of those who interviewed 4 out of 5 denied the allegation. One resident confirmed the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff do not ensure that residents are provided with activities,” therefore, the allegation is unsubstantiated.

No deficiencies were cited for these allegations.

An exit interview was conducted and a copy of this report was provided to the Administrator, Renette DeLaCruz.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3