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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601976
Report Date: 11/10/2025
Date Signed: 11/10/2025 04:33:15 PM

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
10/28/2025 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251028080701
FACILITY NAME:DEL MAR PARKFACILITY NUMBER:
198601976
ADMINISTRATOR:RABIE BANAFSHEHAFACILITY TYPE:
740
ADDRESS:990 EAST DEL MAR BOULEVARDTELEPHONE:
(626) 577-0215
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:124CENSUS: 65DATE:
11/10/2025
UNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Denise Sutton - SupervisorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Staff do not ensure resident has privacy in their room.
Staff interacts with residents in an inappropriate manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint visit to investigate the above allegations and deliver findings. LPA met with Supervisor, Denise Sutton and explained the purpose of the visit.

The investigation consisted of the following: On 11/03/2025, LPA toured the facility, inspected Resident #1 (R1) - Resident #2 (R2) rooms, obtained copies of the following files: staff & resident rosters, in-service training regarding residents rights and privacy (09/18/2024), Resident handbook, 30-day notice of room change provided to R1 (dated 10/20/2025), R1's notes (dated 08/28/2025, 08/29/2025 & 10/27/2025 ), email correspondence (dated 10/15/2025), and (R1)'s files relevant to the investigation. LPA interviewed Staff #1 (S1) - Staff #4 (S4) and Resident #1 (R1) - Resident #6 (R6).

During today’s visit, LPA obtained staff & resident rosters and delivered findings. *****CONTINUED ON LIC9099-C*****
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
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 5
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
10/28/2025 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251028080701

FACILITY NAME:DEL MAR PARKFACILITY NUMBER:
198601976
ADMINISTRATOR:RABIE BANAFSHEHAFACILITY TYPE:
740
ADDRESS:990 EAST DEL MAR BOULEVARDTELEPHONE:
(626) 577-0215
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:124CENSUS: 65DATE:
11/10/2025
UNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Denise Sutton - SupervisorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure resident is being accommodated concerning room and roommate choices.
Staff did not provide a 30 day advance notice of room change.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint visit to investigate the above allegations and deliver findings. LPA met with Supervisor, Denise Sutton and explained the purpose of the visit.

The investigation consisted of the following: On 11/03/2025, LPA toured the facility, inspected Resident #1 (R1) - Resident #2 (R2) rooms, obtained copies of the following files: staff & resident rosters, in-service training regarding residents rights and privacy (09/18/2024), Resident handbook, 30-day notice of room change provided to R1 (dated 10/20/2025), R1's notes (dated 08/28/2025, 08/29/2025 & 10/27/2025 ), email correspondence (dated 10/15/2025), and (R1)'s files relevant to the investigation. LPA interviewed Staff #1 (S1) - Staff #4 (S4) and Resident #1 (R1) - Resident #6 (R6).

During today’s visit, LPA obtained staff & resident rosters and delivered findings. *****CONTINUED ON LIC9099-C*****
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20251028080701
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: DEL MAR PARK
FACILITY NUMBER: 198601976
VISIT DATE: 11/10/2025
NARRATIVE
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The investigation revealed the following:

Allegation: Staff do not ensure resident is being accommodated concerning room and roommate choices. It is alleged that R1 has not been asked about preference for accommodation and being moved to a different room for the 2nd time. During the interview, R1 stated that on 08/28/2025, R1 was moved to a different room and on 10/26/2025, R1 received written notice of another relocation. R1 stated that staff did not ask for their preference regarding room and roommate during the transfer and the notice did not provide important details about the new accommodation. R1 also stated that staff did not follow R1’s care plan to accommodate an adjustable bed that was prescribed to R1 for medical reasons. S1 admitted to not informing R1 about the transfer details and stated that the transfer was necessary because R1 is currently in a private room while R1’s rate is for a shared room. S1 stated that there are no documents to confirm that the private room arrangement was temporary, only verbally. (5) out of (6) residents interviewed stated that they have not requested nor been asked to be transferred to a different room. Documents reviewed showed that R1’s rental agreement (signed and dated on 7/31/2025) included “reasonable accommodations with respect to R1’s preferences concerning apartment and roommate choices.” Additional records reviewed also revealed that R1 was not given information about the right to appeal when R1 did not agree with the room change. Documentation reviewed and interviews conducted corroborate this allegation.

Allegation: Staff did not provide a 30 day advance notice of room change. It is alleged that R1 received a 30 day notice that R1 will be moving to a larger shared apartment on 10/26/25, but was dated 10/20/25. (3) out of (4) staff interviewed confirmed that despite the 30-day notice of room change date of October 20, 2025, the notice was not delivered to R1 until October 26, 2025, along with other correspondence. R1 confirmed during the interview that the 30-day room change notice and other correspondence were left under their door on October 26, 2025. (5) out of (6) residents interviewed stated that they have not been given 30-day notice of room change because they have not been asked to be transferred to a different room. Documents reviewed showed that in addition to failing to provide the 30 day notice to R1 30 days in advance as specified in the rental agreement, the notice is also missing important information and requirements. Interviews conducted as well as reviewed files and documentation corroborate this allegation.

Based on interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Deficiencies cited on the attached LIC 9099D. An exit interview was conducted, and a copy of this report was provided to the Supervisor, Denise Sutton along with the appeal rights.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20251028080701
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: DEL MAR PARK
FACILITY NUMBER: 198601976
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2025
Section Cited
CCR
87468.2(a)(15)
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87468.2 Additional Personal Rights of Residents....(a) In addition to the rights listed in Section 87468.1, Personal Rights...in privately operated residential care facilities for the elderly shall have all of the following personal rights: (15) To reasonable accommodation of their preferences concerning room and roommate choices.
This requirement is not met as evidenced by:
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Licensee/Administrator shall develop a written Plan of Correction to ensure compliance with California Code of Regulations Title 22, Section 87468.2(a)(15) and train all staff on the same regulation. Administrator to submit written POC and in service training log to CCL/LPA by POC due date.
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Based on interviews, records review, the Administrator did not comply with the section cited above in which the staff failed to follow R1’s care plan to accommodate a prescribed adjustable bed for medical reasons, and did not provide important details about the new accommodation including room and roommate choices which poses a potential health, safety or personal rights risk to residents in care.
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Type B
11/17/2025
Section Cited
CCR
87468.2(a)(16)
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87468.2 Additional Personal Rights of Residents...(a) In addition to the rights listed in Section 87468.1, Personal Rights of..residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (16) To written notice of any room changes...30 days in advance unless a room change is agreed to by the resident......
This requirement is not met as evidenced by:
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Licensee/Administrator shall develop a written Plan of Correction to ensure compliance with California Code of Regulations Title 22, Section 87468.2(a)(16) and train staff on the same regulation. Administrator to submit written POC and in service training log to CCL/LPA by POC due date.
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Based on interviews, records review, the Administrator did not comply with the section cited above in which the staff did not provide R1 of the room change notice 30 days in advance which poses a potential health, safety or personal rights risk to residents 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: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20251028080701
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: DEL MAR PARK
FACILITY NUMBER: 198601976
VISIT DATE: 11/10/2025
NARRATIVE
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The investigation revealed the following:

Allegation: Staff do not ensure resident has privacy in their room. It is alleged that R1 did not have privacy because R1 was told by S1 to always keep their apartment door open even during their sleep. All (4) staff interviewed denied the allegation. S1 stated that they respect the residents' privacy and accord them safe and comfortable accommodations. (5) out of (6) residents interviewed denied the allegation. Interviewed residents indicated that no one has told them to always keep their door open, and they are free to open or close their door whenever they choose. During the facility tour, LPA observed some of the residents’ doors were open while others were closed. LPA’s observation and interviews conducted do not corroborate this allegation.

Allegation: Staff interacts with residents in an inappropriate manner. It is alleged that S1 told everyone that R1 was being investigated for an accusation of stealing that was not true. Additionally, staff would wake up R1 very early even if R1 told them not to. All (4) staff interviewed denied the allegation and stated they receive regular training on respecting residents' rights. S1 stated they keep confidential information in order to protect the residents. Staff interviewed stated that they treat the residents with respect and dignity and follow their orders or requests. Some staff interviewed denied knowing any of the residents who were under investigation. R1 stated that they wanted to withdraw this allegation since R1 is planning to leave the facility. (5) out of (6) residents interviewed denied the allegation. Some residents interviewed stated that staff interact with them appropriately and unaware of any resident being investigated. Based on the information obtained, the allegation is unsubstantiated.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, 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 conducted and a copy of this report was provided to Denise Sutton, Supervisor.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5