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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320504
Report Date: 10/22/2025
Date Signed: 10/22/2025 10:54:36 AM

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:
10/22/2025
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Administrator Ibrahim ZayatTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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9
Staff do not ensure facility is maintained in good repair.
INVESTIGATION FINDINGS:
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11
12
13
This report superceeds report dated 10/02/25 due to technical saving error, findings do not change.

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
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
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
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: 10/22/2025
NARRATIVE
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#1-5 (S1-S5). On 10/02/25 LPA conducted a tour of the facility kitchen, common areas, and conducted checks in bedrooms #'s 12,16, 19, and 21.

The investigation revealed the following:
Allegation: Staff do not ensure facility is maintained in good repair.
It is being alleged that some facility bedroom bathrooms do not have hot water, plumbing, lighting, or toilet seats. On 10/02/25 from 9:30am- 10:45 am LPA conducted interviews with C1-C7 regarding the allegation above, 5 of 7 clients interviewed denied the allegation above, 2 of 7 clients interviewed confirmed the allegation and stated they have made maintenance request that have not been addressed. On 10/02/25 from 11am-12pm LPA conducted interviews with S1-S5 regarding the allegation above, 5 of the 5 staff interviewed denied the allegation above. Per 5 of 5 staff interviewed when clients request maintenance services, the services are conducted in real time unless a part needs to be ordered. On 10/02/25 LPA conducted checks of bedrooms # 12, 16, 19, and 21, LPA observed water temperatures to be under 80 F., toilet seats were missing, and toilet tank covers were missing in bathrooms located in bedrooms # 16 and 19, and there was no lighting observed in bedroom #21. LPA did not observe an invoice or receipt to indicate a replacement light has been ordered.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8) are being cited on the attached LIC 9099D.

Exit interview conducted, appeal rights explained, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 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:
10/22/2025
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Administrator Ibrahim ZayatTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to provide proper food service to clients in care.
INVESTIGATION FINDINGS:
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5
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13
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, common 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: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
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: 10/22/2025
NARRATIVE
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5
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The investigation revealed the following:
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 interviewed denied the allegation above, 2 of 7 clients interviewed confirmed the allegation above and stated the menu does not change daily and they are served the same food from previous days. 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 reported 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: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
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: 10/22/2025
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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**Citation has already been cleared from original report.
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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**Citation has already been cleared from original report.
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: 10/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5