198602099-12-19-2025-11-AS-SCIS-DRMW49-20260225155707

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602099
Report Date: 12/18/2025
Date Signed: 12/19/2025 04:50:57 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/10/2025 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20251210130130

FACILITY NAME:	CORAL OAKS CARE LIVING		FACILITY NUMBER:	198602099
ADMINISTRATOR:	ELEANOR BARRIENTOS		FACILITY TYPE:	740
ADDRESS:	4271 CARLIN AVE		TELEPHONE:	(310) 763-4881
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	84	CENSUS: 70	DATE:	12/18/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Ellen Barrintos,		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not provide adequate supervision resulting in a resident eloping from the facility.

INVESTIGATION FINDINGS:

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On December 18, 2025, at 8:30 a.m., Licensing Program Analyst (LPA) Pamela Bunker conducted an initial visit to gather information regarding the above allegations. LPA met with Ellen Barrintos, Administrator, and explained the purpose of the visit. LPA was granted entry to the facility.

The investigation consisted of the following: On December 18, 2025, the following documents were reviewed and/or obtained as part of the investigation: Personnel Report (dated 12/18/2025), Resident Roster (dated 12/18/2025), Special Incident Reports (dated 12/15/2025), Admission Agreement (dated 11/09/2023) Identification and Emergency Information (dated 11/07/2023), Physician’s Report (dated 11/03/2023, 04/18/2024 & 10/05/2025), Medical Assessment (dated 10/05/2025), Medication Administration Records (MARs) (dated 11/01/2025 -12/12/2025), Appraisal & Needs and Services Plan (dated 08/20/2025), Functional Capability Assessment (dated 11/06/2023), Preplacement Appraisal Information (dated 11/06/2023), Personal Rights (dated 11/09/2023), Consent Forms (date 11/09/2023), and
See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025

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 3

Control Number 11-AS-20251210130130

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CORAL OAKS CARE LIVING	FACILITY NUMBER: 198602099
	VISIT DATE: 12/18/2025

NARRATIVE

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Continued LIC9099-C page 2.

In-Service Training (dated 12/10/2025), Sign In and Out Sheet (dated 12/09/2025), La Palma Intercommunity Hospital Medical Records (dated 09/19/2025), and Kaiser Permanente Downey Medical Center Admission and Discharge Records (dated 12/09/2025 and 12/10/2025).

On 12/19/2025, between 10:00 a.m. and 3:00 p.m., LPA Pamela Bunker conducted interviews with staff members #1–#4 (S1–S4) and with residents #2–#6 (R2–R6). Resident #1 (R1) was unavailable for an interview as they no longer reside at the facility. R1 transferring to a higher level of care facility.

The investigation revealed the following.
Allegation: Staff did not provide adequate supervision, resulting in a resident eloping from the facility.
LPA interviewed staff #1–4 (S1-S4). All four staff members (4 out of 4) stated that the facility staff ensure they are providing adequate care and supervision to prevent any resident from eloping from the facility. 4 out of 4 staff members reported that R1 signed out on 12/09/2025. They stated that R1 typically remains on the premises and is known to walk around inside the facility, the patio area, or the outside parking lot. On this date, however, R1 left the facility and went for a walk in the community. During routine rounds conducted every two hours, staff noticed that R1 was no longer at the facility and immediately initiated a search. Staff stated they were able to locate R1 later that same day. S1-S4 stated on 12/09/2025, R1 was admitted to Kaiser Permanente Downey Medical Center for observation. R1 was discharged 12/10/2025. 4 out of 4 staff interviewed stated that R1's CT scan showed no evidence of head trauma, and that a full body check revealed no injuries or bruising. On 12/12/2025, R1 was transferred to a higher-level care facility for continued treatment. Staff confirmed that they self-reported the incident to all the appropriate agencies, responsible parties, family members, and R1's physician in a timely manner. According to staff, 4 out of 4 stated that the facility followed Title 22 regulations and implemented the necessary precautions to ensure resident safety at all times.

Residents #2–#6 (R2–R6) stated that staff provide adequate care and supervision. 5 out of 6 residents reported that staff are always available to assist and consistently check on residents throughout the day and night. 5 out of 6 residents stated that they did not witness any resident eloping from the facility. R2–R6 also reported that their daily needs are being met and that they are happy living at the facility, expressing no problems or concerns. See continued LIC812-C page 2.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20251210130130

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CORAL OAKS CARE LIVING	FACILITY NUMBER: 198602099
	VISIT DATE: 12/18/2025

NARRATIVE

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Continued LIC809-C page 3.

LPA Bunker reviewed Resident #1’s (R1) file, including the Special Incident Report dated December 15, 2025, which confirmed that staff reported the incident to Community Care Licensing, the responsible parties, and all appropriate agencies in a timely manner. LPA Bunker also verified that In-Service Training was conducted on December 10, 2025, covering topics such as making rounds, checking on residents, conducting head counts, reporting changes in condition or behavior, and proper use of the sign-in/sign-out sheet. The sign-out sheet dated December 9, 2025, showed that R1 had signed out.

LPA Bunker reviewed R1 medical records from La Palma Intercommunity Hospital dated September 19, 2025, as well as admission and discharge records from Kaiser Permanente Downey Medical Center dated December 9 and December 10, 2025. The CT scan showed no evidence of head trauma.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the 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 deemed unsubstantiated.

A copy of the Complaint Investigation Report LIC9099 and LIC9099-C was provided to the Ellen Barrintos, Administrator.

No deficiencies were cited.

An exit interview was conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025

LIC9099 (FAS) - (06/04)

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