198600067-7-17-2025-11-AS-SCIS-DK22PQ-20250728173442

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600067
Report Date: 07/17/2025
Date Signed: 07/17/2025 02:40:43 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 HOME		FACILITY NUMBER:	198600067
ADMINISTRATOR:	MARCELO E. MENDOZA		FACILITY TYPE:	735
ADDRESS:	12613 LONG BEACH BLVD		TELEPHONE:	(310) 639-4719
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	48	CENSUS: 22	DATE:	07/17/2025
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Alexis Gallegos-Program Director		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Facility staff did not ensure resident's podiatry needs were met

INVESTIGATION FINDINGS:

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**This report supersedes the original report delivered on 4/24/2025. On 7/17/2025, LPA Allen arrived at the facility to deliver the corrected 9099, which included corrections based on resident interviews conducted for the original report issued on 4/24/2025. Upon arrival, LPA Allen met with Alexis Gallegos-Program director, who was informed of the purpose of the visit.**

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’s (R1) facility file that consisted of SCLARC reassessment transfer referral sheet dated 4/3/2025, ROADS podiatry service sheet dated 4/24/2025, Advance Holistic Healthcare Inc.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025

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-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: 07/17/2025

NARRATIVE

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Podiatric evaluation & treatment sheet dated 4/25/2025, residents service sheet from Holistic Healthcare Inc. dated 2/7/2025, and Notes. LPA also reviewed resident 1 - 5 (R1-R5) files for podiatry treatments dated 12/19/2024, staff roster, resident roster and letter confirming new service provider ROADS dated 6/24/2025. LPA also conducted Interviews with staff members staff 1- 3 (S1-S3), three (3) external witness 1- 3 (W1-W3), Resident 1- Resident 5 (R1-R5).

The investigation revealed the following:

Allegation: 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.

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, Alternative measures were put in place for a podiatrist referral and office visit prior to R1s relocation. Staff also stated services are provided on a quarterly basis and they are currently waiting for podiatric evaluation & treatment service forms for the month of April 2025.

LPA Allen conducted interviews with three external witnesses (W1-W3). 3 out of 3 witnesses confirmed they had been informed by staff about R1's podiatric needs and were aware of R1's prior refusal of services and understood that additional measures were being implemented to address these needs.
LPA attempted to interview resident 1 (R1) on 6/4/2025 who was unable to have a clear conversation. R1 was not able to confirm or deny that podiatric services were provided or not.

On 6/19/2025 LPA Allen, LPA conducted interviews with resident 1 - 5 (R1- R5) of those interviewed 4 out of 4 stated the doctor comes to the facility and provide podiatric needs about every 2-3 months. LPA also observed Evaluation & Treatment sheets dated 12/19/2024. As of April 2025 the podiatrist company has been changed from Valley Community Multi-Care Service, Inc. to R.O.A.D.S Community Care Clinic for R2-R5) and documents reflect if services were been provided for R2-R5. Continue......

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025

LIC9099 (FAS) - (06/04)

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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: 07/17/2025

NARRATIVE

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During interviews LPA observed resident 2-4 feet which appeared that their podiatry needs have been met .
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 Alexis Gallegos-Program Director at conclusion of the visit.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025

LIC9099 (FAS) - (06/04)

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