<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600067
Report Date: 04/24/2025
Date Signed: 04/24/2025 12:39:42 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
04/15/2025 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 11-AS-20250415095000
FACILITY NAME:ANGELICA GUEST HOMEFACILITY NUMBER:
198600067
ADMINISTRATOR:MARCELO E. MENDOZAFACILITY TYPE:
735
ADDRESS:12613 LONG BEACH BLVDTELEPHONE:
(310) 639-4719
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:48CENSUS: 23DATE:
04/24/2025
UNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Joe-Diogenes Valencerina-AdministratorTIME COMPLETED:
12:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not ensure resident's podiatry needs were met.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 4/24/2025, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate and deliver findings for the alleged allegation. LPA identified herself and met Orlando Magat- Support Staff who was informed of the purpose of the visit and allowed LPA entry into the facility.

The investigation consisted of the following:
A review of resident 1 (R1) facility file, interviews with three (3) external witnesses (W1-W3), interviews with three (3) staff members (S1-S3), and review of staff and resident roster.

It is alleged that the facility staff did not ensure resident's podiatry needs were met.

At 9:00 AM, LPA reviewed R1's facility file and records, which revealed that R1 had been assisted with their podiatric needs within the past 6 months. However, LPA observed documents showing that R1 refused care at the time of the physician’s visit.
Continued ...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
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 2
Control Number 11-AS-20250415095000
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: ANGELICA GUEST HOME
FACILITY NUMBER: 198600067
VISIT DATE: 04/24/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
At 9:45 AM, LPA conducted interviews with three (3) staff members (S1-S3), and 3 out of 3 staff members stated R1 was being assisted with their podiatric needs while in care, but R1 had refused services at the time of the physician’s visit.

LPA Allen also conducted interviews with three (3) external witnesses (W1-W3), and 3 out of 3 interviews revealed that all parties had been informed by staff members and were aware of R1's podiatric needs. The three witnesses (W1-W3) stated they were informed of R1's prior refusal of services and that additional measures were being implemented to address these needs.

Based on interviews conducted, documents reviewed and observations the above allegation is found to be Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed and provided to Joe- Diogebes Valencerina- Administrator at conclusion of the visit.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2