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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320504
Report Date: 06/25/2025
Date Signed: 06/25/2025 05:20:33 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
06/20/2025 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250620095157
FACILITY NAME:CHEZ BON GUEST HOMEFACILITY NUMBER:
198320504
ADMINISTRATOR:IBRAHIM ZAYATFACILITY TYPE:
735
ADDRESS:1206 WALNUT AVETELEPHONE:
(562) 591-1411
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:82CENSUS: 79DATE:
06/25/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Noam Sakoff/ Assistant AdministratorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Lack of appropriate care and supervision resulting in residents being left alone for extended periods of time.
INVESTIGATION FINDINGS:
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On 6/25/25, at approximately 11:00 AM, Licensing Program Analyst-LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Noam Sakoff/ Assistant Administrator. LPA explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Client’s interviews (C#1-C#7), Staff Interview (S#1 and S#2). LPA obtained and reviewed the following documents: Client’s roster dated:6/25/25, Personnel Report or LIC 500 dated:2/25, Copy of facility staff schedule dated: 5/19/25, Copies of (C#1-C#7)’s Physicians Report for Community Care Facilities or LIC602 and Preplacement Appraisal Information or LIC 603 dated: 6/15/22, 4/5/22, 4/25/24, 5/23/24, 3/19/19, 9/4/24, 12/31/18.

Evaluation Report continues LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
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-20250620095157
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: CHEZ BON GUEST HOME
FACILITY NUMBER: 198320504
VISIT DATE: 06/25/2025
NARRATIVE
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Investigation Revealed the Following:

Allegation: Lack of appropriate care and supervision resulting in residents being left alone for extended periods of time.

The details of the complaint alleged that clients in care are being left alone for long periods of time day and night.



On June 25, 2025, at approximately 2:00 p.m., during the records review, LPA Iniguez observed a Copy of the facility staff schedule dated May 19, 2025. LPA Iniguez observed that there are (15) facility staff listed on it, and on any regular day, there are approximately (10) facility staff in the morning and afternoon and (3) at nighttime. In addition, LPA Iniguez reviewed the Personnel Report, or LIC 500, dated 2/25. LPA Iniguez observed that the same people listed in the schedule are also listed on the Personnel Report. Moreover, LPA Iniguez reviewed (C#1-C#7)’s Physicians Report for Community Care Facilities or LIC602 and Preplacement Appraisal Information or LIC 603 dated: 6/15/22, 4/5/22, 4/25/24, 5/23/24, 3/19/19, 9/4/24, 12/31/18. LPA Iniguez observed that (7) out of (7) clients in care, it is listed on their reports that they can care for all personal needs, do not need constant medical supervision, and can leave the facility unassisted.

On June 25, 2025, at approximately 11:00 AM, during an interview with the Administrator (A#1), he stated that the facility has enough staff to care for the client’s needs. Additionally, (A#1) stated that clients are not left unsupervised day and night; “we have staff 24/7.” In addition, (A#1) stated that the facility has approximately (10) facility staff in the morning and afternoon and (3) at nighttime.


Evaluation Report continues LIC 9099-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250620095157
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: CHEZ BON GUEST HOME
FACILITY NUMBER: 198320504
VISIT DATE: 06/25/2025
NARRATIVE
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On June 25, 2025, at approximately 11:00 AM, during interviews with clients (C#2-C#7), (7) out of (7) stated that they think there is enough facility staff to take care of them and the rest of the clients. Also, (7) out of (7) clients in care stated that they have never been unsupervised by facility staff, either during the day or at night.

On June 25, 2025, at approximately 3:00 PM, during interviews with facility staff (S#1-S#2), (2) out of (2) they stated that they are enough facility staff to meet the clients needs and they are not left unsupervised day and night. Additionally, (2) out of (2) facility staff stated that the facility has approximately (10) facility staff in the morning and afternoon and (3) at nighttime.

During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.


An exit interview was conducted, and a copy of the Complaint Report was given to Noam Sakoff/ Assistant Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3