198320420-9-10-2025-11-AS-JHAD-DLMN6N-20250918101123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320420
Report Date: 09/10/2025
Date Signed: 09/10/2025 08:44:40 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
09/09/2025 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250909112019

FACILITY NAME:	HAYWORTH TERRACE		FACILITY NUMBER:	198320420
ADMINISTRATOR:	ALDO CASESARIO APOSTOL		FACILITY TYPE:	740
ADDRESS:	325 N HAYWORTH AVE		TELEPHONE:	(323) 655-3101
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	111	CENSUS: 53	DATE:	09/10/2025
		UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Terri Han		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff did not ensure residents' air conditioner was working properly.

INVESTIGATION FINDINGS:

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On September 10, 2025, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial unannounced complaint visit. Terri Han, Assistant to the Administrator, greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegation mentioned above.

The investigation included interviews, a collection of records, and a tour of the facility. Interviews were conducted with Staff #1 and Staff #2 (S1-S2). The Department reviewed several documents, including the Facility Resident Roster (dated 09/10/25), Facility Personnel Roster (dated 09/10/25), Air Conditioning Invoice #0383770 (dated 09/04/25), and (R1's) Physicians Report LIC 602A (dated 11/15/22), as well as other pertinent records associated with this complaint.

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

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-20250909112019

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: HAYWORTH TERRACE	FACILITY NUMBER: 198320420
	VISIT DATE: 09/10/2025

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff did not ensure the residents’ air conditioner was working properly.

The complaint alleges that the staff at the facility did not ensure that Resident #1 (R1's) air conditioner was functioning correctly. It has been reported that the air conditioner in the middle hallway on the second floor is either broken or malfunctioning, while the rest of the floor below is operating correctly and remains cool. No additional information about this situation was provided.

On September 10, 2025, between 10:00 AM and 12:00 PM, the Department interviewed staff members identified as Staff #1 and Staff #2. Two (2) of the two (2) staff members were unable to validate this claim. (S1) stated that the air conditioning (AC) unit in room #45 is functioning correctly for Resident #1 (R1). In contrast, (S2), who has been closely monitoring service records for (R1), has not reported any issues with the air conditioning system.

(S1) mentioned that (R1) informed about the AC system's malfunction on August 27, 2025. (S1) inspected the thermostat unit that controls rooms #33, #41, #42, #45, and #46. The thermostat, located in the second-floor hallway, is securely enclosed in a clear plastic lockbox. However, it had been tampered with and turned off. (S1) explained that residents often attempt to adjust the thermostat in the middle of the night without access to the key, leading them to tamper with the lockbox.

To resolve the issue, (S1) had to reset the circuit breaker panel located on the rooftop where the Central Air Conditioner Condenser unit for rooms #33, #41, #42, #45, and #46 is situated. According to (S1), the AC was operational for several days but failed on September 1, 2025, due to a malfunction in the compressor. (S1) noted that compressors can fail due to electrical issues, blocked coils, overheating, contamination from dirt or moisture, and imbalanced refrigerant levels. (S1) reported compressor part was immediately ordered and on September 4, 2025, the new part was installed by AC specialist and AC was in working condition. (S1) indicated that (R1) received an oscillating tower fan to cool the entire room while awaiting part replacement.

On September 10, 2025, the Department conducted an inspection of the thermostats on the second floor, focusing on the thermostat unit for room #45, which is designated as (R1’s) private room. All thermostats were found to be functioning correctly. Furthermore, rooms #33, #41, #42, #45, and #46 were also inspected, and it was observed that the air conditioning units in these rooms were operational.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250909112019

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: HAYWORTH TERRACE	FACILITY NUMBER: 198320420
	VISIT DATE: 09/10/2025

NARRATIVE

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The inspection covered the common areas on the first floor, which included the lobby, activity rooms, and dining area. All of these areas are equipped with functioning air conditioning units. Additionally, the Department inspected the rooftop circuit breaker panel connected to the Central Air Conditioner Condenser unit that serves rooms #33, #41, #42, #45, and #46, confirming that it was in working condition. An oscillating tower fan located in room (R1) was also found to be functioning correctly. The temperature in (R1’s) room ranged from 68°F to 74°F, which is compliant with Title 22 regulations.

A review of the Air Conditioning Invoice #0383770 (dated 09/04/25) confirmed that the ordered part was replaced promptly, and the labor involved was verified. Additionally, an examination of (R1’s) Physician’s Report LIC 602A (dated 11/15/22) and the Appraisal/Needs Service Plan LIC 625 (dated 06/28/22) indicated that (R1) did not have respiratory or cardiovascular conditions that could present physical or mental conditions with improper room temperature (ref: National Institute of Health NIH).

Resident #1 (R1) was unavailable for an interview during the investigation.

Based on the information gathered, there is not enough evidence to support the allegation mentioned above.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above 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.

An exit interview was conducted with Terri Han, and copies of the reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC9099 (FAS) - (06/04)

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