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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601818
Report Date: 05/28/2026
Date Signed: 05/28/2026 05:24:34 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
05/22/2026 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260522131642
FACILITY NAME:ELWYN NC - SCENICFACILITY NUMBER:
198601818
ADMINISTRATOR:LAURIE HERNANDEZFACILITY TYPE:
734
ADDRESS:11526 SCENIC DRTELEPHONE:
(408) 558-1500
CITY:WHITTIERSTATE: CAZIP CODE:
90601
CAPACITY:4CENSUS: 4DATE:
05/28/2026
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Nancy Reyes, RNTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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1. Staff did not ensure that medications were inaccessible to clients in care.
2. Staff did not accurately maintain client's medication records.
3. Staff did not properly dispose of expired medications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegations listed above. LPA arrived unannounced and met with Nurse, Nancy Reyes. The purpose of the visit was explained.

LPA obtained a copy of the staff roster, client roster, and checked medications. Interviews were held with four (4) Staff and one (1) Client. LPA obtained a copy of the Regional Center Corrective Action Plan and the Department of Developmental Services’ semi-annual monitoring report.

The investigation revealed the following:
Allegation - Staff did not ensure that medications were inaccessible to clients in care. Staff acknowledged that in April 2026 during an audit review from the Department of Developmental Services, an error was found.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
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 4
Control Number 28-AS-20260522131642
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: ELWYN NC - SCENIC
FACILITY NUMBER: 198601818
VISIT DATE: 05/28/2026
NARRATIVE
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One of the clients' probiotic blend medication that needed to be refrigerated was not kept locked in the small refrigerator. The medication was placed outside of the locked box in the refrigerator. Staff stated that they recently added a lock to the small refrigerator. LPA observed that the medications are centrally stored and locked in the medication cart. The facility uses a small refrigerator to store any medications that need to be refrigerated. The refrigerator door has a lock and was locked at the time of visit.

Allegation - Staff did not accurately maintain client's medication records. It is alleged that the staff did not initial the Medication Administration Record (MAR) when the morning medication (Levothyroxine) was given on 4/1/26. Staff acknowledged the error and stated that staff forgot to initial the MAR when the medication was administered to the client. Staff were provided an in-service training after the error. LPA checked the medication with the MAR logs today. There were no discrepancies found.

Allegation - Staff did not properly dispose of expired medications. It is alleged that the expired medications were found in the overflow basket. Staff acknowledged that one of the clients’ medications (Enema) had expired during an audit review. Staff stored the expired medication within the overflow basket in the locked cabinet and had not disposed of the expired medication. Per staff, the Department of Developmental Services and Regional Center reports noted that the Enema medication expired on 10/19/24 per the affixed pharmacy label. LPA observed the overflow medications and expired medications stored separately in a locked cabinet.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 1), are being cited on the attached LIC 9099D.



An exit interview was conducted. The Plan of Corrections were reviewed and developed with Administrator Hazel Gatan. A copy of this report and appeal rights were provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20260522131642
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: ELWYN NC - SCENIC
FACILITY NUMBER: 198601818
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/29/2026
Section Cited
CCR
80075(k)(1)
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80075 Health Related Services (k) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons...
This requirement is not met as evidenced by:
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Administrator shall provide an in-service training to staff who handle medication. The log shall be submitted to LPA by 5/29/26.

**The in-service training log was given to LPA during the visit.
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Based on interviews and record review, one of the clients' medication was accessible in the small refrigerator which posed an immediate health and safety risk to clients in care.
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Type A
05/29/2026
Section Cited
CCR
80065(a)
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80065 Personnel Requirements (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.
This requirement is not met as evidenced by:
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The administrator shall provide a plan to ensure staff are documenting medication when given and submit to LPA by 5/29/26.

**The in-service training log was given to LPA during the visit.
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Based on record review and interview, staff did not initial the MAR log as given which posed an immediate 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: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20260522131642
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: ELWYN NC - SCENIC
FACILITY NUMBER: 198601818
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/29/2026
Section Cited
CCR
80075(l)
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80075 Health Related Services (l) Prescription medications which are not taken with the client upon termination of services, or which are not to be retained shall be destroyed by the facility administrator...
This requirement is not met as evidenced by:
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Administrator shall provide an in-service training regarding expired medication and a plan to destroy the expired medications by POC due date 5/29/26.
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Based on interview and record review, a medication that had been expired was placed within the overflow medication which posed an immediate 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: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4