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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601672
Report Date: 10/07/2025
Date Signed: 10/07/2025 02:02:07 PM

Unsubstantiated


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
09/30/2025 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250930085547
FACILITY NAME:CLAREMONT MANORFACILITY NUMBER:
198601672
ADMINISTRATOR:ROBERT BARTONFACILITY TYPE:
740
ADDRESS:650 W. HARRISON AVE.TELEPHONE:
(909) 626-1227
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:360CENSUS: 238DATE:
10/07/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tanya Madrid and Minerva NaranjoTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not ensure that resident received medical treatment in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an investigation to investigate the above allegation. LPA met with Tanya Madrid and discussed the purpose of today's visit.

During today's visit, LPA obtained copies of the staff and resident rosters, interviewed Staff #1 (S-1) through Staff #3 (S-3), interviewed Resident #1 (R-1) through Resident #4 (R-4), interviewed R-1's Physical Therapist, reviewed R-1's file and obtained relevant documentation. LPA also called R-1's Power of Attorney (POA) and left a message for a return call. All interviewed residents are residing in the memory care unit (where allegation allegedly occurred) and the census for the memory care unit is (21). LPA was unable to interview additional residents from this unit.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
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-20250930085547
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: CLAREMONT MANOR
FACILITY NUMBER: 198601672
VISIT DATE: 10/07/2025
NARRATIVE
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Allegation: Staff did not ensure that resident received medical treatment in a timely manner. It has been alleged that R-1 has not received physical therapy since sustaining an injury a few months ago. Staff interviews revealed that R-1 sustained an injury on 07/01/25 which resulted in R-1 requiring physical therapy services. Interviewed staff indicated that R-1 was sent to the hospital on 07/01/25 for treatment and was discharged on 07/05/25 to the on-site Skilled Nursing Facility (SNF) for rehabilitation. Per interviews (including interview with R-1’s Physical Therapist), R-1 received therapy during their stay at the SNF. Per interviews, R-1 was discharged back to this facility on 07/31/25 under hospice care. Per interviews, due to hospice care being in place, there was a delay with obtaining billing authorization for R-1 to receive physical therapy services. Per interviews, R-1’s POA was aware of the pending authorization for therapy services (meeting was held with R-1’s POA on 08/07/25). Per R-1’s Physical Therapist interview, R-1 began receiving therapy on 08/27/25 at this facility (once the authorization request was approved). Per interviews, the delay for physical therapy services for R-1 was due to the pending authorization approval and not due to staff not ensuring R-1 received medical treatment in a timely manner. Resident interviews revealed that they receive medical treatment in a timely manner and that they do not have any concerns. Interviews and documentation reviewed do not corroborate this allegation.

Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, a copy of the report and appeal rights were provided to Minerva Naranjo

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2