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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320504
Report Date: 10/02/2025
Date Signed: 10/02/2025 03:37:03 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, 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
09/24/2025 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20250924110343
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: 78DATE:
10/02/2025
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Administrator Ibrahim ZayatTIME COMPLETED:
03:28 PM
ALLEGATION(S):
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Staff do not ensure facility is maintained in good repair.
INVESTIGATION FINDINGS:
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On 10/02/25 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Administrator Ibrahim Zayat (S1) as the purpose of today’s visit was explained.

The investigation consisted of the following: On 10/02/25 LPA Villegas obtained copies of the staff and client rosters, facility cleaning schedule, facility menus and copies of the following documents for clien #1 (C1) face sheet, admission agreement dated: 12/05/16 , Physicians report dated: 12/31/18, needs and service plan dated: 04/15/2024, functional capabilities assessment, facility rules and regulations and medication administration record (MAR) for September 2025 and October 2025. On 10/02/25 from 9:30am- 10:45 am LPA conducted interview with Client #1-7 (C1-C7), and from 11am-12pm LPA conducted interview with staff #1-5 (S1-S5). On 10/02/25 LPA conducted a tour of the facility kitchen, coomon areas, and conducted checks in bedrooms #'s 12,16, 19, and 21.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
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 5
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
09/24/2025 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20250924110343

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: 78DATE:
10/02/2025
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Administrator Ibrahim ZayatTIME COMPLETED:
03:28 PM
ALLEGATION(S):
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5
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9
Facility failed to provide proper food service to clients in care.
INVESTIGATION FINDINGS:
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On 10/02/25 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Administrator Ibrahim Zayat (S1) as the purpose of today’s visit was explained.

The investigation consisted of the following: On 10/02/25 LPA Villegas obtained copies of the staff and client rosters, facility cleaning schedule, facility menus and copies of the following documents for clien #1 (C1) face sheet, admission agreement dated: 12/05/16 , Physicians report dated: 12/31/18, needs and service plan dated: 04/15/2024, functional capabilities assessment, facility rules and regulations and medication administration record (MAR) for September 2025 and October 2025. On 10/02/25 from 9:30am- 10:45 am LPA conducted interview with Client #1-7 (C1-C7), and from 11am-12pm LPA conducted interview with staff #1-5 (S1-S5). On 10/02/25 LPA conducted a tour of the facility kitchen, coomon areas, and conducted checks in bedrooms #'s 12,16, 19, and 21.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20250924110343
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: 10/02/2025
NARRATIVE
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Allegation: Facility failed to provide proper food service to clients in care.

It is being alleged that clients in care are provided with the same food items ever day, and are not provided with fresh fruit or vegetables. On 10/02/25 from 9:30am- 10:45 am LPA conducted interviews with C1-C7 regarding the allegation above, 5 of 7 clients denied the allegation above, 2 of 7 clients interviewed confirmed the allegation above and stated the menu does not change daily. On 10/02/25 from 11am-12pm LPA conducted interview with S1-S5 regarding the allegation above, 4 of 5 staff interviewed denied the allegation above and reported can goods may be used from time to time. Additionally, 1 of the 4 staff reported that a menu item may be repeated throughout the week. 1 of 5 staff interviewed reporting have no knowledge of the food service. On 10/02/25 LPA conducted a tour of facility kitchen and pantry, LPA observed a supply of fresh fruit and vegetables, as well as an assortment of canned vegetables.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, and a copy of this report was provided to Ibrahim Zayat.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20250924110343
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2025
Section Cited
CCR
80088(e)(1)
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80088 Furniture, Fixtures, Equipment, and Supplies Faucets used by clients for personal care.. shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temp of not less
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Administrator to adjust the water heater, and continue to check the water temperatures in all bedrooms.
Administrator will self-certify water temperatures are within required range of 105F-120F and submit proof to LPA by POC due date.
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than 105 degrees F and not more than 120 degrees F. This requirement was not met as water temperatures in bedroom bathrroms 12,16, 19, and 21 were observed to not be within range of 105 F -120 F. which poses a potential health, safety or personal rights risk to persons in care.
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Type B
10/16/2025
Section Cited
CCR
80087(a)
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80087 buildings and grounds The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as bathrooms 12,16, 19, and 21
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Administrator to make necessary repairs to get into compliance, LPA to obtain proof of repairs by POC due date.
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were observed to not be without a toilet set, and/or tank cover, or without light which poses a potential health, safety or personal rights risk to persons in care.
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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: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5