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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600106
Report Date: 11/20/2025
Date Signed: 11/20/2025 11:21:26 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/23/2025 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251023183931
FACILITY NAME:D'CORDIAL MANORFACILITY NUMBER:
198600106
ADMINISTRATOR:RENATO MADRIGALFACILITY TYPE:
735
ADDRESS:14746 ZASTROW AVETELEPHONE:
(562) 925-8125
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:4CENSUS: 2DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Victor Taclob, StaffTIME COMPLETED:
10:50 AM
ALLEGATION(S):
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Staff hit resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to deliver findings for the allegation listed above. LPA met with Staff and explained the reason for the visit.

The investigation consisted of the following:
On 10/30/25, LPA Chan conducted the initial visit to collect documents for Client #1. Interviews were held with a staff and client. Additional interviews were held with the administrator, Client #1, and day program personnels via telephone on different dates.

The investigation revealed the following:
Allegation – Staff hit client. It is alleged that a facility staff hit Client #1 (C1) and sustained a black eye and a busted retinal vessel on the right eye. LPA interviewed facility staff who denied hitting C1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
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 28-AS-20251023183931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: D'CORDIAL MANOR
FACILITY NUMBER: 198600106
VISIT DATE: 11/20/2025
NARRATIVE
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Staff stated they did not notice any black eye or a red spot on C1’s right eye while getting client ready for the day program. Staff stated they saw a red spot on C1’s eye when C1 was brought back to the facility. Staff stated they observed a red spot, which looked like a popped blood vessel in the right eye, and some discoloration under the eye. However, staff did not observe a black eye as indicated. LPA interviewed two (2) day program personnel. Program staff stated that they saw darkness around C1’s right eye and a red spot which looked like a blood clot. Both facility staff and day program staff did not observe C1’s eye worsening over the following days. Per the record review, C1 was seen by the physician on 10/28/25, and the doctor’s note indicated that C1 had a subconjunctival hemorrhage of the right eye with no trauma. LPA interviewed both clients. Clients stated that the facility staff take care of them and never hit them.

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; therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted. A copy of this report, along with the appeal rights, was provided to the staff.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2