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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601574
Report Date: 04/09/2026
Date Signed: 04/09/2026 01:06:44 PM

Substantiated


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
08/27/2025 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250827144321
FACILITY NAME:CARTAGENA HOMEFACILITY NUMBER:
198601574
ADMINISTRATOR:MARIA CHRISTINA SERAFICOFACILITY TYPE:
735
ADDRESS:1306 CARTAGENA STREETTELEPHONE:
(562) 988-8142
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:4CENSUS: 4DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Maria Christina Serafico/Program DirectorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff did not properly care for client resulting in illness.
INVESTIGATION FINDINGS:
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On 4/8/2026 LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Maria Cristina Serafico/Program Director. LPA explained the purpose of this visit.

Investigation Consisted of: the department conducted the following interviews: Administrator Interview (A#1), Facility Staff Interviews (S#1-S#2), Clients Interviews (C#1-C#4) and Witness Interview (W#1). The department gathered the following documentation: Copy of (C#1)’s hospital records from Whittier Hospital Medical Center dated: 6/29/25, copy of (C#1)’s Death Certificate dated:7/14/25, copy of Incident Report by Long Beach Police Department (LBPD) dated:10/1/25, copy of Emergency Medical Services (EMS) and 911 call recording-Long Beach Fire Department(LBFD) dated: 10/1/25, copy of (C#1)’s hospital records from Long Beach Medical Center dated:10/3/25, copy of (C#1)’s service coordinator from Harbor Regional Center dated: 10/10/25.

Evaluation Report continues LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
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 10
Control Number 11-AS-20250827144321
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: CARTAGENA HOME
FACILITY NUMBER: 198601574
VISIT DATE: 04/09/2026
NARRATIVE
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Investigation Revealed the Following:

Allegation: Staff did not properly care for client resulting in illness.

The details of the complaint alleged that facility failed to care for (C#1)’s medical needs resulting in illness.

On 11/25/2025, the Department found, in its investigation, that the facility failed to provide the required services for (C#1) and did not properly respond to their change in condition, which may have prolonged their suffering. There was no Licensed Vocational Nurse (LVN) at the facility on 6/28/2025 as needed to provide three hours of daily care. The overnight staff on 6/28/2025 into 6/29/2025 did not inform (C#1)’s clinical team about their chest congestion during the 3-6 hours before their breathing problems were noticed. Also, staff did not provide the necessary medication, Geri-Tussin, to ease (C#1)’s chest congestion, partly because they were not certified to administer medication as required. The facility Quality Improvement Specialist said, “There is a preponderance of evidence to support (C#1) had a change of condition during the Noc shift on 6/29/25; no medications were administered during this time.”

During this investigation, LPA found sufficient evidence to support the above-mentioned allegation.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D).

An exit interview was conducted, and a copy of the Complaint Report was given to Maria Cristina Serafico/Program Director.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 10
Control Number 11-AS-20250827144321
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: CARTAGENA HOME
FACILITY NUMBER: 198601574
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/27/2026
Section Cited
CCR
85075.4
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85075.4 Observation of the Client
(a) The licensee shall regularly observe each client for changes in physical, mental, emotional and social functioning.

This requirement was not met as evidence by:
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Licensee will adhere to Title 22 at all times. As a plan of correction, the licensee will conduct an in-service training for facility staff regarding the client's changes in condition. Proof of the training will be sent to LPA Iniguez via email before the POC due date.
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Based on observation, interviews and record review, facility staff failed to ensure to provide the required services for (C#1) and did not properly respond to their change in condition. This poses a potential health and safety risk to clients 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: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 10
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
08/27/2025 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250827144321

FACILITY NAME:CARTAGENA HOMEFACILITY NUMBER:
198601574
ADMINISTRATOR:MARIA CHRISTINA SERAFICOFACILITY TYPE:
735
ADDRESS:1306 CARTAGENA STREETTELEPHONE:
(562) 988-8142
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:4CENSUS: 4DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Maria Christina Serafico/Program DirectorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Questionable Death
Staff failed to provide adequate supervision for client in care.
Staff failed to assist client with hygiene needs.
Client sustained an unexplained black eye.
INVESTIGATION FINDINGS:
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On 4/8/2026 LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Maria Cristina Serafico/Program Director. LPA explained the purpose of this visit.
Investigation Consisted of: the department conducted the following interviews: Administrator Interview (A#1), Facility Staff Interviews (S#1-S#2), Clients Interviews (C#1-C#4) and Witness Interview (W#1). The department gathered the following documentation: Copy of (C#1)’s hospital records from Whittier Hospital Medical Center dated: 6/29/25, copy of (C#1)’s Death Certificate dated:7/14/25, copy of Incident Report by Long Beach Police Department (LBPD) dated:10/1/25, copy of Emergency Medical Services (EMS) and 911 call recording-Long Beach Fire Department(LBFD) dated: 10/1/25, copy of (C#1)’s hospital records from Long Beach Medical Center dated:10/3/25, copy of (C#1)’s service coordinator from Harbor Regional Center dated: 10/10/25, (C#1)’s Admission Agreement dated:6/30/20, copy of (C#1)’s preplacement appraisal information or LIC 603 dated:8/27/2019, copy of (C#1)’s service coordinator (SC) notes from Harbor Regional Center dated:6/17/25, copy of staff training log dated:1/6/26.

Evaluation Report continues LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 10
Control Number 11-AS-20250827144321
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: CARTAGENA HOME
FACILITY NUMBER: 198601574
VISIT DATE: 04/09/2026
NARRATIVE
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Investigation Revealed the Following:

Allegation: Questionable Death

The details of the complaint alleged that (C#1)’s death was due to facility negligence.

On 11/25/2025, the Department conclude in their investigation that (C#1) had a history of respiratory issues and dysphagia and experienced multiple pneumonias prior to 2024. After a period without incidents, they were hospitalized on June 29, 2025, for pneumonia following a sudden decline noted early that morning. Vital signs had been normal in the days prior, though the facility had reported coughing during meals to the primary care physician, who advised continuing the current diet and obtaining a speech evaluation. Medical records do not indicate whether the pneumonia was viral, bacterial, contagious, or aspiration-related, and it is unknown whether earlier treatment would have changed the outcome. (C#1) developed sepsis and multi-organ failure and later died. The investigation could not determine whether the pneumonia or death were preventable, and the allegation of neglect was found to be unsubstantiated.

Allegation: Staff failed to provide adequate supervision for client in care.

The details of the complaint alleged that facility failed to provide adequate


supervision to (C#1) while living there.

On April 8, 2026, during the records review process, the department reviewed (C#1)’s Admission Agreement dated:6/30/20. The department noted that, in the admissions agreement, as part of the services provided, the facility will conduct ongoing health observations and continuous in-house supervision, unless a written exception is granted by the regional center and licensing agency (Title 22, 80024). In addition, the department observed a copy of (C#1)’s preplacement appraisal information, or LIC 603, dated 8/27/2019. The department noted that it was written that (C#1) would receive, as part of the services needed, special medication attention and assistance in incidental health and medical care.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 10
Control Number 11-AS-20250827144321
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: CARTAGENA HOME
FACILITY NUMBER: 198601574
VISIT DATE: 04/09/2026
NARRATIVE
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Moreover, the department reviewed a copy of (C#1)’s service coordinator (SC) notes from Harbor Regional Center dated 6/17/25. The department noted that (SC) wrote, “No concerns have been reported over the past quarter. All benefits remain stable. Behavior has been relatively stable (the ABACS Behavior Consultant was unable to attend this meeting). Overall, Cartagena Home continues to provide (C#1) with the appropriate level of care and supervision they require”.

On March 3, 2026, during an interview with Administrator (A#1), (A#1) stated that the facility maintained two staff members on each shift (AM, PM, and NOC) as part of (C#1)’s supervision plan. (A#1) explained that supervision was implemented by assigning designated staff to monitor (C#1) and provide care as needed. Care included diaper changes, repositioning, feeding, and bathing. Staff documented regular observations of (C#1)’s behavior, mood, and safety status. Environmental safety measures were maintained to keep (C#1) in observable areas. (A#1) also reported that staff communicated during shift changes to ensure continuity of care. (C#1)’s supervision needs were reviewed and adjusted based on ongoing assessments. (A#1) further stated that if any incidents or concerns regarding supervision were reported, the involved staff would be placed on administrative leave pending investigation. According to (A#1), incidents were reviewed collaboratively by Harbor Regional Center, Sevita Quality Improvement, and facility management. (A#1) added that staff received refresher training on medication procedures and supervision as a proactive measure.

On March 3, 2026, during an interview with Witness 1 (W#1), they stated that they did not recall directly observing Client #1 (C#1) or the other clients (C#2–C#4) being left unsupervised. (W#1) reported that their notes reflected adequate staff-to-resident ratios during both announced and unannounced visits to the facility. (W#1) further stated that during their most recent in-person visit with (C#1) and (C#2–C#4), staff members were frequently checking on, interacting with, and engaging the clients throughout the visit.

On April 8,2026, the department could not speak with (C#1) since they passed away on 7/12/25.

On April 8,2026, the department was not able to speak with (C#2-C#4) due to their cognitive impairment.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 10
Control Number 11-AS-20250827144321
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: CARTAGENA HOME
FACILITY NUMBER: 198601574
VISIT DATE: 04/09/2026
NARRATIVE
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On April 8,2026, during interviews with facility staff (S#1-S#2), (2) out of (2) stated that there are always two Direct Support Professionals (DSPs) on duty during each shift and that clients are never left unsupervised. Staff reported that they sit with the clients when they are watching television and conduct regular checks when clients are in their rooms. In addition, when asked if they had observed any situations in which Client #1 (C#1) or other clients (C#2-C#4) required additional supervision and did not receive it, (2) out of (2) staff denied ever witnessing such incidents.

Allegation: Staff failed to assist client with hygiene needs.

The details of the complaint alleged that facility failed to meet (C#1)’s hygiene needs.

On April 8, 2026, during the records review process, the department reviewed (C#1)’s Admission Agreement dated:6/30/20. The department noted that, in the admissions agreement, as part of the services provided, the facility will assist (C#1) with grooming. In addition, the department observed a copy of (C#1)’s preplacement appraisal information, or LIC 603, dated 8/27/2019. The department noted that it was written that (C#1) would receive, as part of the services needed help with bathing, hair care, and personal hygiene. The department noted that (SC) wrote, “No concerns have been reported over the past quarter. All benefits remain stable. Overall, Cartagena Home continues to provide (C#1) with the appropriate level of care and supervision they require”.

On March 3, 2026, during an interview with Administrator (A#1), (A#1) stated that clients receive hygiene assistance based on individualized care plans developed from assessments of their needs. Staff are trained to follow these plans, maintain appropriate supervision, and provide bathing, grooming, and oral care while preserving dignity and privacy. Daily hygiene routines are established, documented, and reviewed by supervisory staff. (A#1) reported that for (C#1), the care plan required verbal prompting and physical assistance. Staff provided reminders, assisted with setup, and helped complete scheduled hygiene tasks. Documentation reflected consistent care and maintenance of privacy.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 10
Control Number 11-AS-20250827144321
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: CARTAGENA HOME
FACILITY NUMBER: 198601574
VISIT DATE: 04/09/2026
NARRATIVE
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(A#1) further stated that (C#1) required regular assistance with ADLs, including repositioning every two hours and changing as needed. Staff responded by providing supervision and hands-on support, documenting all care provided. According to (A#1), (C#1)’s hygiene needs were consistently addressed in accordance with the care plan.

On March 3, 2026, during an interview with Witness 1 (W#1), they stated that they did not recall observing staff failing to assist Client #1 (C#1) or the other clients (C#2–C#4) with hygiene tasks such as bathing, grooming, or changing clothes. (W#1) further stated that during their visits, they did not observe any instances in which (C#1) or (C#2–C#4) appeared to need hygiene assistance but did not receive it. To the best of (W#1)’s recollection, they were not made aware of any specific incidents in which (C#1) or (C#2–C#4) required hygiene assistance and did not receive it.

On April 8,2026, the department could not speak with (C#1) since they passed away on 7/12/25.

On April 8,2026, the department was not able to speak with (C#2-C#4) due to their cognitive impairment.

On April 8,2026, during interviews with facility staff (S#1-S#2), (2) out of (2) stated that clients have an established daily hygiene routine. Staff reported that some clients require daily diaper changes, and staff assist clients with showers, brushing their hair, and providing necessary personal care supplies. Staff further stated that while some clients can complete their own hygiene tasks, others require staff assistance. In addition, when asked if they had noticed any concerns regarding hygiene for Client #1 (C#1) or other clients (C#2-C#4), (2) out of (2) staff stated that they had not observed any hygiene concerns at the facility.

Allegation: Client sustained an unexplained black eye.

The details of the complaint alleged that (C#1) sustained a black eye while living at the facility.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 8 of 10
Control Number 11-AS-20250827144321
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: CARTAGENA HOME
FACILITY NUMBER: 198601574
VISIT DATE: 04/09/2026
NARRATIVE
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On April 8, 2026, during the records review process the department reviewed the copy of staff training log dated:1/6/26. The department noted that facility conducted in-service training on Individual rights.

On March 3, 2026, during an interview with Administrator (A#1), (A#1) stated that during their tenure, beginning in March 2023, they were not aware of any incident in which (C#1) sustained a black eye. (A#1) reported that no such injury had been brought to their attention and no related incident had occurred. (A#1) further stated that supervision and safety measures were consistently in place, including two staff on each shift (AM, PM, and NOC), daily LVN support for three hours, weekly RN supervision, and routine oversight by the Program Director and Program Supervisor. (A#1) reported that safety precautions are always observed to ensure clients’ health and well-being.

On March 3, 2026, during an interview with Witness 1 (W#1), W#1 stated that they did not observe Client #1 (C#1) or the other clients (C#2–C#4) with a black eye. In addition, (W#1) also stated that they were not aware of any incident or situation that could have caused such an injury. Moreover, (W#1) reported that no incident involving a black eye for (C#1) had been documented.

On April 8,2026, the department could not speak with (C#1) since they passed away on 7/12/25.

On April 8,2026, the department was not able to speak with (C#2-C#4) due to their cognitive impairment.

On April 8,2026, during interviews with facility staff (S#1-S#2), (2) out of (2) stated that they had not observed any injuries on Client #1 (C#1) or any other clients (C#2-C#4), including the reported black eye. Staff reported that they had never seen such an injury during their shifts. Additionally, when asked if they were aware of any incidents involving (C#1) or other clients (C#2-C#4) that could have resulted in injuries, (2) out of (2) staff stated that they were not aware of any such incidents.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 9 of 10
Control Number 11-AS-20250827144321
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: CARTAGENA HOME
FACILITY NUMBER: 198601574
VISIT DATE: 04/09/2026
NARRATIVE
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During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

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.

An exit interview was conducted, and a copy of the Complaint Report was given to Maria Cristina Serafico/Program Director.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
Page: 10 of 10