198601838-6-28-2025-28-AS-DSIS-DJ6SZ3-20250701141829

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601838
Report Date: 06/28/2025
Date Signed: 06/28/2025 01:22:46 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
06/17/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250617085953

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: 132	DATE:	06/28/2025
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Jorge Pena - LVN		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff are not providing healthful accommodations for the residents
Staff do not prevent residents from mistreating another resident
Staff do not meet the needs of a resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint visit to deliver findings for the above allegation. LPA met with LVN Jorge Pena and explained the purpose of today's visit.

The investigation consisted of the following:
On 6/26/25 LPA obtained copies of staff/resident rosters, toured facility, obtained copies of Special Incident Reports (SIR's) and interviewed 5 staff and 13 residents.
On 6/27/25 LPA obtained documents via email within R1's file that are relevant to investigation.
On 6/28/25 LPA delivered findings for above allegation.

(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: 06/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025

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-20250617085953

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: 06/28/2025

NARRATIVE

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The investigation revealed the following:
Allegation: Staff are not providing healthful accommodations for the residents.
It is alleged that residents smoke near rear exit of the facility near the dining area with the door open and this causes the dining room to be polluted with the smell of smoke. LPA toured facility and did not observe the smell of smoke in the dining room or in the lobby as mentioned. LPA interviewed 5 staff and 5 out of 5 staff denied the above allegation and stated that although residents do need redirection on the smoking areas from time to time, there have been no observations of the air within the facility being polluted with smoke. LPA interviewed 13 residents and 11 out of 13 residents denied the above allegation and stated that they have not observed the air in the facility being polluted with smoke, some agreed that residents sometimes begin to smoke right near the front door but staff are quick to redirect them and guide them to the approved smoking areas.

Allegation: Staff do not prevent residents from mistreating another resident.
It is alleged that R1 has been insulted by Residents (R2, R3, R4) and they continue to threaten and insult them, with staff doing nothing to prevent this from reoccurring. LPA interviewed 5 staff and 5 out of 5 staff denied the above allegation and stated that when there are altercations between residents the residents are separated from each other and spoken to separately, staff de-escalate the situation and will report to management and next shift so that residents are monitored. Interview with S1 revealed that R1 has had many verbal arguments with residents and has been spoken to previously about avoiding confrontation with others. LPA reviewed 7 Special Incident Reports (SIRs) where it was documented that R1 had a verbal argument with residents and was reminded of the house rules and to avoid confrontation with residents. LPA interviewed 13 residents and 12 out of 13 residents denied the above allegation and stated that staff intervene when residents get into disputes/disagreements and are separated and spoken to separately. Interviews with R2,R3 and R4 revealed that each resident has had a verbal altercation with R1 as R1 tends to tell them what to do, each stated that staff did get involved and spoke to them individually to remind them of the house rules and to avoid future verbal alterations.

(continued on LIC9099-C)

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250617085953

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: 06/28/2025

NARRATIVE

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Allegation: Staff do not meet the needs of a resident while in care.
It is alleged that R5 defecates and vomits on the lobby furniture and in the dining area and staff does nothing to assist resident. LPA interviewed 5 staff and 5 out of 5 staff denied the above allegation, staff stated that although R5 has had accidents in the past, caregivers and housekeeping are notified right away and resident is provided with assistance/cleaning and the areas are cleaned up immediately. LPA interviewed 13 residents and 12 out of 13 residents denied the above allegation and stated that the staff is able to meet their needs.

Based on statements and interviews conducted with staff, tour of facility, and client record review, there was not enough supportive evidence to concur with the reported allegations. 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, therefore the allegations are 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: 06/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025

LIC9099 (FAS) - (06/04)

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