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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601744
Report Date: 06/16/2026
Date Signed: 06/16/2026 08:01:56 PM

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
06/10/2026 and conducted by Evaluator Gabriela Castro
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260610160018
FACILITY NAME:JOHN AND MARY DUCE CENTREFACILITY NUMBER:
198601744
ADMINISTRATOR:GARCIA, NOEYFACILITY TYPE:
735
ADDRESS:523 N. CHANDLER AVETELEPHONE:
(626) 289-8766
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY:6CENSUS: 6DATE:
06/16/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Josie Lopez, House Manager & Alex Stott, Administrator TIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Due to neglegance of staff, resident was missing medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced complaint visit on 06/16/2026 to deliver findings related to the above allegation. LPA met with Administrator Alex Stott and House Manager Josie Lopez and explained the purpose of the visit.

The investigation included a review of the client roster, staff roster, C1's face sheet, C1's Physician's Report, physician medication orders, and the Special Incident Report (SIR). Additionally, the LPA observed C1's medications and conducted interviews with two staff members (S1-S2) and C1. LPA also attempted to interview clients C2-C4; however, due to cognitive limitations, the clients were unable to understand the questions being asked

(continued on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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-20260610160018
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: JOHN AND MARY DUCE CENTRE
FACILITY NUMBER: 198601744
VISIT DATE: 06/16/2026
NARRATIVE
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It is alleged that facility staff failed to properly administer and account for C1's prescribed medication, resulting in a medication error involving Magnesium Glycinate. On 03/29/2026, one 100 mg tablet of Magnesium Glycinate designated for the evening medication pass was unaccounted for. During staff interviews, S2 reported discovering the discrepancy while conducting the morning medication pass. S2 stated that C1 was prescribed a total of 400 mg of Magnesium Glycinate, administered through separate 100 mg bubble packs, and observed that one tablet intended for the evening medication pass was missing. S1 explained that it was possible the evening dose had been administered during the morning medication pass; however, staff were unable to determine with certainty whether the medication had been administered at the incorrect time or whether the evening dose had been missed altogether. S2 reported immediately notifying the on-call supervisor and explained that staff contacted the pharmacy for guidance. S1 stated that the pharmacy advised that the potential missed or incorrectly administered dose was not expected to result in adverse effects. Staff further reported that C1 was assessed and monitored throughout the remainder of the day, and no signs of distress or adverse symptoms were observed. S2 indicated that an incident report was completed, photographs of the medication bubble packs were obtained to document the discrepancy, and S1 reported additional medication training was provided following the incident. Staff also reported implementing corrective measures, including enhanced medication checks after each medication pass and reorganizing medication storage to better separate morning and evening medications.

During client interviews, C1 communicated through the use of a voice computer and stated that they could not recall the incident. C1 apologized for not being able to provide additional information and further stated that they liked living at the facility. LPA attempted to interview clients C2 through C4; however, due to cognitive limitations, they were unable to understand the questions being asked.

Based on LPA's 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, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260610160018
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: JOHN AND MARY DUCE CENTRE
FACILITY NUMBER: 198601744
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/17/2026
Section Cited
CCR
80075(b)
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80075 (b)Clients shall be assisted as needed with self-administration of prescription and nonprescription medications

This requirement is not met as evidenced by:
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Administrator shall submit a written plan describing the measures that have been implemented to ensure medications are administered as prescribed. The plan shall include procedures for medication verification, documentation requirements, staff responsibilities, and the steps to be taken in the event of a medication error by POC due date. Proof of Staff Training was provided to LPA on 6/16/26.
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Based on observations, interviews, and record review, the facility failed to comply with the cited section, as C1's prescribed medication was not administered as prescribed. This deficiency posed an immediate health, safety, or personal rights risk 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: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3