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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600567
Report Date: 06/29/2026
Date Signed: 06/29/2026 12:47:41 PM

Substantiated


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
06/23/2026 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260623091317
FACILITY NAME:SANTOS HOME-LAKEWOODFACILITY NUMBER:
198600567
ADMINISTRATOR:JAY S. SAMILINFACILITY TYPE:
735
ADDRESS:5719 OLIVA AVE.TELEPHONE:
(562) 531-7118
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:4CENSUS: 3DATE:
06/29/2026
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Rhona AmadoTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Staff do not keep the facility free from pests.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted an initial complaint visit to investigate the above allegations. LPA met with DSP staff Luz Obcena and discussed the purpose of today's visit. Administrator Rona Amado arrived shortly.

During this visit, LPA Gutierrez toured home and obtained a copy of the staff and client rosters. LPA also obtained pest control documents and recent special incident reports (SIR). LPA interviewed Administrator, staff #1-staff #2(S1-S2), clients# 1-clients #3 (R2-R9) and witness #1-witness #2 (W1-W2). LPA Gutierrez delivered findings.

Refer to LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
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 3
Control Number 28-AS-20260623091317
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: SANTOS HOME-LAKEWOOD
FACILITY NUMBER: 198600567
VISIT DATE: 06/29/2026
NARRATIVE
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In regard to the allegation” Staff do not keep the facility free from pests”, It is alleged that C1 attended the Adult Day Program, and when C1 opened snack bag, numerous small cockroaches crawled out. During interviews with Administrator and staff two (2) out of three (3) staff stated that this is an old home and there are only pests because of weather. All three (3) staff stated home gets sprayed for bugs. During interviews with clients three (3) out of three (3) stated they have seen bugs in their lunch pails. Only one client stated that he/she has seen pest control spray home. During interview with W2 it was stated that this has happened before with another client from same home. LPA toured the facility and observed numerous cockroaches on the side of stove stuck to a white sticky bug catcher, small roaches in kitchen cabinets, small bugs in both bathrooms behind toilet bowl, gnats flying in restroom #1, and gnats flying around kitchen were LPA was typing report. It was also observed that facility had numerous bug trap plug in's throughout house, two electric fly swatters, and OFF family spray in kitchen. LPA spoke with customer service for pest control who confirmed that facility had pro services performed on home which focused on exterior of home and after incident 06/22/2026 facility changed to premium plan.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted, and a copy of this report, LIC 421 FC civil penalty assessment for repeat violation, and appeal rights were provided.

A civil penalty of $250.00 is being assessed today.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260623091317
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: SANTOS HOME-LAKEWOOD
FACILITY NUMBER: 198600567
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2026
Section Cited
CCR
80087(a)(1)
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80087 Buildings and Grounds
(a) 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.
(1) The licensee shall take measures to keep the facility free of flies and other insects.

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Due to this being a repeat violation facility has changed there pest control plan from pro to premium plan focusing more on the interior.
Facility will clean areas in kitchen and bathroom and send LPA pictures by POC due date.
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Based on interviews and observation, LPA observed small live bugs crawling next to stove,in kitchen cabinets,bathrooms and kitchen desk area 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: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3