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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601122
Report Date: 09/15/2025
Date Signed: 09/15/2025 02:11:57 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
09/11/2025 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250911144605
FACILITY NAME:INSPIRATION HOMES IIFACILITY NUMBER:
198601122
ADMINISTRATOR:MARSHA HAYWOODFACILITY TYPE:
735
ADDRESS:6745 NORTH GOLDEN WEST AVE.TELEPHONE:
(626) 445-7959
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:4CENSUS: 4DATE:
09/15/2025
UNANNOUNCEDTIME BEGAN:
01:09 PM
MET WITH:Joseph Haywood, Lead DSP. TIME COMPLETED:
02:19 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not administer resident medication causing resident to miss a dose.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alberto Lopez made an unannounced visit to investigate the above allegation. LPA met with Joseph Haywood, Lead DSP and explained the purpose of the visit.
The investigation consisted of LPA interviewing Three (3) staff (S#1- S#3) and Three (3) (R#1 -R#3) residents, obtaining and reviewing copies of staff roster, client face sheets, C1 MAR for September 2025, and SIR dated September 7, 2025.
The investigation revealed: Allegation: Staff did not administer resident medication causing resident to miss a dose. It is alleged that staff did not administer one (1) medication at 8:00am on 09/05/2025 to C1 and S1 initialed C1 MAR as given when it was not given to client. S1 admitted to the error and stated that C1 doctor was called the same day and recommended that facility skip the dose that was missed and continue the next day. Administrator (S3) stated she is aware of the error and sent SIR to the department. The administrator stated that they are in the process of training the entire staff at the facility.
Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22) cited on the attached 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
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-20250911144605
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: INSPIRATION HOMES II
FACILITY NUMBER: 198601122
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2025
Section Cited
CCR
89975(b)
1
2
3
4
5
6
7
80075(b)

Health Related Services. Medications shall be given according to physician's directions.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Facility Administrator will conduct in-service on administration of medications for all staff that administer medication and will create a written plan explaining how facility will make sure medications are administered following physicians orders and how often training will be conducted with staff.
8
9
10
11
12
13
14
C1 was not administered medication at 8:00AM on 09/05/2025 and was marked as given by S1 in C1 MAR which did not follow physicians orders, which posed a potential health and safety or personal rights risk to people in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2