198601962-4-11-2025-28-AS-RORN-DGEUGG-20250506153420

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601962
Report Date: 04/11/2025
Date Signed: 04/11/2025 11:50:59 AM

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
01/27/2025 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250127105952

FACILITY NAME:	SOUTHLAND LIVING		FACILITY NUMBER:	198601962
ADMINISTRATOR:	TRAN, VICTORIA		FACILITY TYPE:	740
ADDRESS:	11701 STUDEBAKER ROAD		TELEPHONE:	(562) 406-7326
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	75	CENSUS: 45	DATE:	04/11/2025
		UNANNOUNCED	TIME BEGAN:	08:12 AM
MET WITH:	Administrator Victoria Tran		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Staff is under the influence of drugs while caring for residents
Staff do not safeguard residents' medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Administrator Victoria Tran and explained the purpose of the visit.

The investigation consisted of the following: During the initial visit conducted on 01/28/2025, LPA conducted a health and safety check. LPA obtained copies of the following documents: staff roster, resident roster, and checked three (3) random residents’ medications for any errors or discrepancies. On 01/27/2025 our investigation branch (IB) assisted with this investigation. During today’s visit LPA Gutierrez interviewed Administrator Tran, staff 1 (S1) by telephone, S2-S6, residents R1-R5, and delivered findings.

SEE 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Christian Gutierrez	TELEPHONE: 323-981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025

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-20250127105952

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: SOUTHLAND LIVING	FACILITY NUMBER: 198601962
	VISIT DATE: 04/11/2025

NARRATIVE

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In regard to the allegation “Staff is under the influence of drugs while caring for residents”, it is alleged that a staff member goes to work high while caring for residents. During interviews with staff five (5) out of five (5) all deny ever taking drugs or witnessing any staff do drugs. During interviews with residents five (5) out of five (5) all stated they never witnessed or felt staff were under the influence of drugs while caring for them. R1 stated that this is a nice facility, and all the staff is great. Investigator Dennis Douglas from the Investigation branch (IB) conducted interviews with Administrator and one (1) staff concerning the above allegation and found no discrepancies based on his two interviews.

In regard to the allegation “Staff do not safeguard residents' medication”, it is alleged that staff has had empty cartons of medication with labels ripped off in their possession. During interviews with staff five (5) out of five (5) stated that there have been no problems with medication or any medication missing from med room or carts. Administrator stated some residents are able to keep medication in their rooms in a lock box and that none have reported any thing missing. During interviews with residents five (5) out of five (5) residents all stated they have never been missing any medication or had any problems with medications being dispensed by med -techs. During initial investigation LPA Gutierrez did a random medication check and there were no errors or discrepancies.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the 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.

An exit interview was conducted, and a copy of this report was given to Administrator Victoria Tran.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Christian Gutierrez	TELEPHONE: 323-981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025

LIC9099 (FAS) - (06/04)

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