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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602192
Report Date: 05/29/2025
Date Signed: 05/29/2025 12:40:12 PM

Substantiated


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
05/22/2025 and conducted by Evaluator Mayra Cota
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250522082132
FACILITY NAME:SAKURA GARDENS AT LOS ANGELESFACILITY NUMBER:
198602192
ADMINISTRATOR:JINA MALEKSARKISSIANSFACILITY TYPE:
740
ADDRESS:325 S BOYLE AVETELEPHONE:
(323) 263-9651
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY:183CENSUS: 128DATE:
05/29/2025
UNANNOUNCEDTIME BEGAN:
08:19 AM
MET WITH:Dennis Robeniol, Executive Director TIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Staff did not ensure hot water was available at the facility for residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted an initial unannounced complaint visit to investigate the above allegation. LPA met with Dennis Robeniol, Executive Director and explained the reason for the visit.

The investigation consisted of the following:

LPA, Cota, obtained copies of client and staff rosters, toured common areas of the facility, inspected 14 resident rooms/bathrooms and interviewed Resident 1 - Resident 9 (R1-R9) and Staff 1 - Staff 5.

***Continues on LIC 9099C
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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 28-AS-20250522082132
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: SAKURA GARDENS AT LOS ANGELES
FACILITY NUMBER: 198602192
VISIT DATE: 05/29/2025
NARRATIVE
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Regarding: Staff did not ensure hot water was available at the facility for residents in care.

It is alleged, the victim hasn't had hot water for the past 4 days and therefore, wants to return back home.



The investigation revealed the following:

Water temperature measured by LPA revealed to be between 89.6 - 91.7 degrees F in 10 out of 14 resident bathrooms inspected, which is below the compliance range of 105 - 120 degrees F. S1-S3 corroborate the allegation. Interviews with S1-S3 indicated, water temperature is inconsistent and they are aware water is not delivered at an adequate temperature especially in the morning. S1-S3 stated, residents have complained regarding the water not being hot enough. Interviews with S4-S5 indicated, residents have complained to them regarding water not being delivered hot by their restroom's tap for several days. R1-R9 also corroborate the allegation. Interviews with R1-R9. indicated, their bathroom sinks do not deliver hot water which interferes with their showers and other personal hygiene routines. R1-R9 stated, they have brought it to the attention of staff, however, the issue persists.

LPA, substantiated the allegation above based on the evidence obtained during this investigation. A finding of substantiated means the allegation is valid because the evidence meets the preponderance of the evidence standard. LPA cited the deficiency below per California Code of Regulations (CCR) Title 22.

***See LIC 9099-D

An exit interview was conducted with Dennis Robeniol, Executive Director. A hard copy of the report and Appeal Rights were provided at the time of visit.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250522082132
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: SAKURA GARDENS AT LOS ANGELES
FACILITY NUMBER: 198602192
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/30/2025
Section Cited
CCR
87303(e)(2)
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87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a
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Licensee will send LPA, work order from vendor with ET of repair by due date. Licensee will monitor water temperature for three days in the morming and the evening and ensure water is within Title 22 regulation. Licensee will send water temperature log by June 2, 2025.
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temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).
The licensee did not comply with the section cited above as water temperature in 10 resident's bathrooms measured at 89.9 and 91.7, which poses an immediate health, safety or personal righs risk to persons 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.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3