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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601166
Report Date: 02/07/2026
Date Signed: 02/07/2026 10:28:06 AM

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
01/30/2026 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260130124839
FACILITY NAME:GLEN MEADOWS ANNEXFACILITY NUMBER:
198601166
ADMINISTRATOR:ALYCE EASTONFACILITY TYPE:
735
ADDRESS:1385 NORTH MENTOR AVETELEPHONE:
(626) 791-1690
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:6CENSUS: 6DATE:
02/07/2026
UNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Monique JordanTIME COMPLETED:
10:35 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is operating out of ratio
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met Monique Jordan with who assisted with today’s visit.

The investigation consisted of the following: During the initial visit conducted on 02/03/2026 LPA obtained copies of the following documents: Staff roster, client roster, employee phone numbers, and time sheet report. LPA interviewed Administrator and staff #1 (S1). LPA did a phone interview with staff #2 (S2). On 02/06/2026 LPA conducted phone interviews with staff #3-Staff #5 (S3-S5). On today’s visit LPA Gutierrez delivered findings.

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

DATE: 02/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2026
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-20260130124839
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: GLEN MEADOWS ANNEX
FACILITY NUMBER: 198601166
VISIT DATE: 02/07/2026
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
In regard to the allegation” Facility is operating out of ratio” It is alleged that facility operates out the specific ratio set by Regional Center. This home is vendored at a 1:2 ration (1-staff to 2-residents). During interview with Administrator, and staff four (4) out of six (6) stated that there are times facility works out of ratio. Administrator stated if staff calls out or is late there might be only two staff until coverage is found. S5 stated that it usually happens for a few hours. During record review of timesheets, it was discovered the following :01/30/2026 S1 and S3 were only two staff working from 4:00pm-4:53pm, from 4:53pm-8:03pm S6 and S3 only two staff working, and from 8:03pm-10:00pm S6 was only staff working. On 01/31/2026 from 1:53 pm -6:57pm S7 and S3 only two staff working. During a home visit on 01/23/2026 at 3:40 pm Regional Center staff observed five clients and one staff member present.

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 was provided.

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

DATE: 02/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260130124839
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: GLEN MEADOWS ANNEX
FACILITY NUMBER: 198601166
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2026
Section Cited
CCR
85065.5(a)(1)
1
2
3
4
5
6
7

85065.5 Day Staff-Client Ratio
(a) Whenever a client who relies upon others to perform all activities of daily living is present, the following minimum staffing requirements shall be met:
(1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center but no less than one direct care staff to three such clients.

1
2
3
4
5
6
7
Administrator will submit a written plan on what to do when multiple staff call out and to ensure facility is always operating within set ratio.
8
9
10
11
12
13
14
Based on interviews and record review, the licensee did not comply with the section cited above as this home is vendored at a 1:2 ration (1-staff to 2-residents). On 01/30/2026-01/31/2026 record review indicated facility was operating out of ration set by Regional Center. On 01/23/2026 during a home visit regional staff observed facility operating out of ratio. This poses a potential health and safety risk to persons 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: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3