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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601211
Report Date: 05/28/2025
Date Signed: 05/28/2025 01:47:43 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
03/03/2025 and conducted by Evaluator Felisa Shirley
COMPLAINT CONTROL NUMBER: 11-AS-20250303091900
FACILITY NAME:VILLA STANLEYFACILITY NUMBER:
198601211
ADMINISTRATOR:NATALIE SINGHFACILITY TYPE:
735
ADDRESS:335 N. STANLEY AVETELEPHONE:
(323) 937-4856
CITY:LOS ANGELESSTATE: CAZIP CODE:
90036
CAPACITY:80CENSUS: 71DATE:
05/28/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Natalie Singh, AdministratorTIME COMPLETED:
01:50 PM
ALLEGATION(S):
1
2
3
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5
6
7
8
9
Staff did not ensure the facility is kept clean
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/28/25 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit to the address listed above. LPA Shirley arrived and spoke to the Administrator, Natalie Singh and the purpose of the visit was discussed. LPA was granted access to the facility.

The investigation consisted of the following:

On 3/5/25 LPA requested and reviewed copies of the following records: Client Roster, Staff roster, client file, MAR for 2/25 and 3/25 and fumigation service records from both Rhino Pest Control and Terminix. LPA Shirley conducted a facility tour including client’s rooms 204, 205, and 206. LPA interviewed Staff 1 – Staff-6 and Client 2 – Client 6. Client 1 refused to be interviewed.
Con'd on 9099-C

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
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 7
Control Number 11-AS-20250303091900
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: VILLA STANLEY
FACILITY NUMBER: 198601211
VISIT DATE: 05/28/2025
NARRATIVE
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Allegation: Staff did not ensure the facility is kept clean

The details of the complaint allege that there were cigarette butts everywhere. During file review, LPA Shirley reviewed the Admission Agreement and observed that there are several outdoor areas where smoking is permitted and residents are requested to use the ashtrays. On 3/5/25, LPA Shirley toured this facility and observed that this facility is clean and the staff cleaning the facility on each floor. LPA Shirley observed the staff mopping the floors of the facility. During interviews LPA Shirley ask the Administrator, Natalie Singh for copies of the cleaning schedule. Natalie stated that there were no cleaning schedules, the staff just know where and when to clean.

LPA interviewed staff, staff 1 – staff 6 (S-1 – S-6). LPA asked, if staff ensures that this facility is kept clean. Of those interviewed 6 out of 6 stated yes. LPA interviewed client 2 – client 7 (C-2 – C-7). LPA asked clients, if staff ensures that this facility is kept clean. Of those interviewed, 5 out of 6 answered, yes and 1 answered no.

Based on records review, interviews and observations, LPA did not find sufficient evidence to support the above allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
03/03/2025 and conducted by Evaluator Felisa Shirley
COMPLAINT CONTROL NUMBER: 11-AS-20250303091900

FACILITY NAME:VILLA STANLEYFACILITY NUMBER:
198601211
ADMINISTRATOR:NATALIE SINGHFACILITY TYPE:
735
ADDRESS:335 N. STANLEY AVETELEPHONE:
(323) 937-4856
CITY:LOS ANGELESSTATE: CAZIP CODE:
90036
CAPACITY:80CENSUS: 71DATE:
05/28/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Natalie Singh, AdministratorTIME COMPLETED:
01:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure the facility was free of pests
Staff did not ensure resident's room is kept clean
Staff did not ensure the lights were not in disrepair in resident's room
Staff are not meeting resident's medical needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 5/28/25 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit to the address listed above. LPA Shirley arrived and spoke to the Administrator, Natalie Singh and the purpose of the visit was discussed. LPA was granted access to the facility.

The investigation consisted of the following:

On 3/5/25 LPA requested and reviewed copies of the following records: Client Roster, Staff roster, client file, MAR for 2/25 and 3/25 and fumigation service records from both Rhino Pest Control and Terminix. LPA Shirley conducted a facility tour including client’s rooms 204, 205, and 206. LPA interviewed Staff 1 – Staff-6 and Client 2 – Client 6. Client 1 refused to be interviewed.

The investigation revealed the following:
Con'd on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 11-AS-20250303091900
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: VILLA STANLEY
FACILITY NUMBER: 198601211
VISIT DATE: 05/28/2025
NARRATIVE
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5
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Allegation: Staff did not ensure the facility was free of pests

On 3/5/25, LPA Felisa Shirley reviewed Fumigation invoice records dated 2/24/25 which indicated that this facility is serviced for bed bugs every other week by Rhino Pest Control and Terminix Commercial records dated 2/26/25. Service reports for pest control list rooms where pest were observed and that were treated on that specific day. LPA Shirley toured rooms #204 and #205 and observed the presence of pest in the pockets of the clients’ mattresses.

LPA interviewed staff, staff 1 – staff 6 (S-1 – S-6). LPA asked, does staff ensure that this facility is free from pest. Of those interviewed 3 out of 6 stated yes and 3 answered something other than yes or no. LPA interviewed client 2 – client 7 (C-2 – C-7). LPA asked clients, does staff ensure that this facility is free from pest. Of those interviewed, 2 out of 6 answered, yes and 4 answered no.

Based on observations, information gathered and reviewed, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.



Allegation: Staff did not ensure resident's room is kept clean

During an Interview with Administrator, Natalie Singh stated that it is an ongoing problem that C1 does not allow anyone in the room to be cleaned. During the tour of the facility, LPA Shirley and S5 attempted to inspect room #206. LPA Shirley could not fully open the door as there were objects blocking the door. LPA Shirley attempted to turn the light switch on but the lights were not working. LPA Shirley observed that the windows were blackened with what appeared to be black paint.

Con'd on 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 11-AS-20250303091900
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: VILLA STANLEY
FACILITY NUMBER: 198601211
VISIT DATE: 05/28/2025
NARRATIVE
1
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3
4
5
6
7
8
9
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12
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LPA interviewed staff, staff 1 – staff 6 (S-1 – S-6). LPA asked, does staff ensure that residents rooms are clean. Of those interviewed 4 out of 6 stated yes and 2 answered something other than yes or no. LPA interviewed client 2 – client 7 (C-2 – C-7). LPA asked clients, if staff make sure that their room is clean. Of those interviewed, 6 out of 6 answered, yes.

Based on observations, information gathered and reviewed, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.


Allegation: Staff did not ensure the lights were not in disrepair in resident's room

The details of the complaint alleged that the lights were not working in C1’s room. During the tour of the facility, LPA Shirley and S5 attempted to inspect room 206. LPA Shirley turned the light switch on and observed that the lights were not working. LPA observed the light switch in the up position which indicated the lights should be on. LPA Shirley observed that the windows were blackened with what appeared to be black paint.



LPA interviewed staff, staff 1 – staff 6 (S-1 – S-6). LPA asked, does staff ensure that the lighting in the rooms work. Of those interviewed 4 out of 6 stated yes and 2 answered something other than yes or no. LPA interviewed client 2 – client 7 (C-2 – C-7). LPA asked clients, if the lights in their rooms work. Of those interviewed, 6 out of 6 answered yes.

Based on observations, information gathered and reviewed, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.


Con'd on 9099-C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 11-AS-20250303091900
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: VILLA STANLEY
FACILITY NUMBER: 198601211
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2025
Section Cited
CCR
80087(a)(1)
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80087(a)(1) Buildings and Grounds
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. The licensee shall take measures to keep facility free of flies and other insects.
This requirement was not met as evidenced by:
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The licensee shall take measures to keep the facility free of bed bugs and other insects. This facility is the only facility that continues to have bed bugs. The Licensee needs to sit down with Pest control representatives to get a plan in place, as most facilities has gotten out of this situation. Submit the written plan on how the facility will control the ongoing problem with bedbugs at the facility and in resident’s bedrooms by the POC due date of 6/27/25. Please forward copies of plan to LPA Felisa Shirley at felisa.shirley@dss.ca.gov or fax to 424-544-1016
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Based on observations and interviews conducted, this facility has an ongoing problem with bedbugs. LPA Shirley observed in clients rooms #204, and #205 and located in the mattresses in which contamination of bed bugs poses an immediate health and safety risk to persons in care.
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Type B
06/27/2025
Section Cited
CCR
85169(a)(1)
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85169 Medical Examination
(a) Immediately following each manual restraint or seclusion, the administrator or administrator's designee shall have an in-person communication with the client to assess and determine whether there is a physical injury or suspected physical injury and whether a medical examination by qualified medical professional is needed.
(1) The decision and rationale whether to seek a medical examination shall be documented in the client's record.

This requirement was not met as evidence by:


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The Licensee shall document contact with the PCP regarding Client being medication non-compliant and try to work on client seeing the doctor again making sure to document each attempt and please forward Please forward copies of attempts to LPA Felisa Shirley at felisa.shirley@dss.ca.gov or fax to 424-544-1016 by POC due date of 6/27/25

POC due date of 6/27/25.
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Based on observations, the licensee failed to ensure that client see his primary care physician on a regular basis and seeks medical attention on a timely basis. This poses as a potential health and safety violation 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: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 11-AS-20250303091900
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: VILLA STANLEY
FACILITY NUMBER: 198601211
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2025
Section Cited
CCR
80072(a)(2)
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7
80072 Personal Rights
(a) Except for children’s..., each client...have personal rights...not limited to, the following:
(2) To be accorded..healthful..comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement was not met as evidence by:
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The Licensee shall ensure that clients room is cleaned once again and sanitized and equipped with required bed, bedding, chair, nightstand and lighting. If not able to please document attempts and pictures by POC due date of 6/27/25. Please forward copies to LPA Felisa Shirley at felisa.shirley@dss.ca.gov or fax to 424-544-1016
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Based on observations and interviews conducted, the licensee failed to ensure that C1 has a clean and sanitized room. Ensure that room #206 is equipped with all required furniture and has a sanitized bed and bedding, lighting, and healthful and comfortable accommodations.
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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: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7