198601838-6-5-2025-28-AS-RORN-DHHV7R-20250610161134

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601838
Report Date: 06/05/2025
Date Signed: 06/05/2025 02:34:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/29/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250529135356

FACILITY NAME:	DOWNEY RETIREMENT CENTER		FACILITY NUMBER:	198601838
ADMINISTRATOR:	BRANDIE MENDIBLES		FACILITY TYPE:	740
ADDRESS:	11500 DOLAN AVENUE		TELEPHONE:	(562) 869-2416
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY:	252	CENSUS: 133	DATE:	06/05/2025
		UNANNOUNCED	TIME BEGAN:	09:21 AM
MET WITH:	Brandie Mendibles - Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility water is not regulated at the required temperature.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegations. LPA met with Administrator Brandie Mendibles and explained the purpose of today's visit, shortly affter Assistant Administrator Jason Perez arrived to assit with todays visit.

The investigation consisted of the following:
LPA obtained copies of Staff and Resident Rosters, a tour of the facility was conducted where LPA tested water temperature in the Kitchen and 5 Resident Rooms. LPA interviewed Administrator Brandie.

(continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250529135356

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DOWNEY RETIREMENT CENTER	FACILITY NUMBER: 198601838
	VISIT DATE: 06/05/2025

NARRATIVE

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The investigation revealed the following:
Allegation: Facility water is not regulated at the required temperature
It is alleged that the water within the kitchen is not within the required reading and measured at 70 degrees F. LPA toured facility and measured water temperature within Kitchen (residents do not have access to kitchen) and water temperature measured at 120.7 degrees F, per requirement there is to be a sign posted where water temperature exceeded the required range of 105-120 degrees F and facility had required sign posted that reads, Warning, Water Temperature Exceeds 120 degrees F. LPA toured facility both first and second floors including memory care, there was a total of 5 private resident restrooms where water temperature was tested and each were within the required range. (unsubstantiated)

Based on statements and interviews conducted with staff, tour and water temperature that was tested throughout facility, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is 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 held, and a copy of this report was provided.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025

LIC9099 (FAS) - (06/04)

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