198601976-9-11-2025-28-AS-DSIS-DLKKDJ-20250916074848

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601976
Report Date: 09/11/2025
Date Signed: 09/11/2025 02:09:26 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
09/10/2025 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250910102233

FACILITY NAME:	DEL MAR PARK		FACILITY NUMBER:	198601976
ADMINISTRATOR:	RABIE BANAFSHEHA		FACILITY TYPE:	740
ADDRESS:	990 EAST DEL MAR BOULEVARD		TELEPHONE:	(626) 577-0215
CITY:	PASADENA	STATE: CA	ZIP CODE:	91106
CAPACITY:	124	CENSUS: 65	DATE:	09/11/2025
		UNANNOUNCED	TIME BEGAN:	09:56 AM
MET WITH:	Denise Sutton Medical Coordinator		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident does not have a call signal button in the room
Resident is not being provided assistance per care and needs plan
Staff entered resident's room without permission resulting in broken furniture

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced complaint investigation visit regarding above allegations. LPA met with Denise Sutton Medical Coordinator and explained the reason for the visit.

The investigation consisted of the following: LPA requested a copy of resident/staff roster, conducted a tour of the facility and observed 5 resident bedrooms. LPA interviewed five (5) residents and six (6) staff and requested a copy of admission agreement, physician’s report, preplacement appraisal, and apparel needs and service plan for resident #1(R1).

SEE LIC 9099C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

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 2

Control Number 28-AS-20250910102233

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: 09/11/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

In regard to the allegation “Resident does not have a call signal button in the room”, it is alleged that there is no call button in residents’ room and residents must call facility phone number to request assistance with care. During interviews with staff six (6) out of six (6) stated that all bedrooms are provided with a pull cord in bathrooms. S1 stated that residents are assessed and if determined that a resident is frail and in need of additional assistance a call pendent is provided. Staff stated residents call on their cell phones or room phones if assistance is needed. LPA observed five pull cords in residents’ bathrooms. During interviews with residents four (4) out of five (5) residents stated that they all have pull cords in restrooms and if needed they use their phones for assistance. LPA was not allowed entry in R1’s bedroom and a request for an interview was denied.

In regard to the allegation “Resident is not being provided assistance per care and needs plan”, it is alleged that resident is not being provided adequate assistance with transfers from bed to wheelchair due to R1 being tall and caregivers being too small for his/her weight. During interviews with staff six (6) out of six (6) stated that there is enough staff to properly transfer all clients, and facility even has Hoyer lifts if needed. All staff stated that residents care and needs plans are being followed. During interviews with residents five (5) out of six (6) residents stated that all of there care and needs are being met by staff. LPA attempted to interview R1 but was denied.

In regard to the allegation “Staff entered resident's room without permission resulting in broken furniture”, it is alleged that staff broke a residents table when cleaning room. During interviews with staff five (5) out of six (6) staff stated that to their knowledge nothing has been broken in resident’s bedroom. S1 stated that he/she did hear of an allegation of a broken table, but no proof was ever submitted. During interviews with residents three (3) out of six (6) residents stated that they have never had anything broken due to a staff entering their room. Two (2) residents stated that a small Christmas decoration and a bidet was accidentally broken when housekeeping was cleaning but not on purpose. LPA attempted to interview R1 but was denied.

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 provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2