198602192-1-22-2026-28-AS-FFIS-DX9QKT-20260824121449

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602192
Report Date: 01/22/2026
Date Signed: 01/22/2026 03:37:33 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
01/15/2026 and conducted by Evaluator Luis DeLeon

COMPLAINT CONTROL NUMBER: 28-AS-20260115123528

FACILITY NAME:	SAKURA GARDENS AT LOS ANGELES		FACILITY NUMBER:	198602192
ADMINISTRATOR:	JINA MALEKSARKISSIANS		FACILITY TYPE:	740
ADDRESS:	325 S BOYLE AVE		TELEPHONE:	(323) 263-9651
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90033
CAPACITY:	183	CENSUS: 127	DATE:	01/22/2026
		UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Administrator Dennis Robeniol		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not notify resident’s authorized representative of incident involving resident.
Staff did not properly clean/wipe resident resulting in an UTI.
Staff does not ensure water temperature was appropriate for residents.
Staff does not maintain resident’s hygiene.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Bonnie Tao and Luis De Leon conducted an initial unannounced complaint investigation visit for the allegations listed above. LPAs met with the Administrator Dennis Robeniol and explained the reason for the visit.

Investigation consisted of interviews with staff from staff #1 (S1) to staff #8 (S8), residents from residents #1 (R1) to resident #9 (R9), and a visitor (V1). In addition, physical plant and R1’s facility file review were conducted.

The investigation reveals the following:
In regards of allegation of staff did not notify resident’s authorized representative for an incident involving resident. Per residents' interviews, one (1) out of nine (9) residents interviewed was attempted but unable to contact residents. (Report continues on LIC-9099c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026

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-20260115123528

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: 01/22/2026

NARRATIVE

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Eight (8) out nine (9) residents interviewed indicated that there had been no issues in contacting authorized representatives. Per staff interviews, seven (7) out of seven (7) staff were not able to corroborate the allegation. Staff interviews revealed that staff described the procedure to follow in order to notify authorized representative. On document review, facility has provided training to notify authorized representative as required. Therefore, the staff has followed the procedure in the facility training to notify authorized representatives.

In regards of allegation of staff did not properly clean/wipe resident resulting in an UTI. Per residents' interviews, one (1) out of nine (9) residents interviewed was attempted. Eight (8) out nine (9) residents interviewed indicated that residents have not had any cleaning concerns that may cause an UTI issue. Residents indicated that staff are following residents cleaning and shower schedule twice a week or as per needed. Per staff interviews, all staff were not able to corroborate the allegation. Per document review, R1’s Medication Administrator Record (MAR) does not show any medication treatment for UTI. Staff are provided annual training for UTI care. During physical plant, LPA’s observed staff checking diapers and diaper changes were done. LPAs observed residents are provided drinking water in residents rooms and during their meals. Staff ensure that residents are hydrated. Therefore, there is no preponderance evidence to show that staff did not properly clean assistance and result in UTI.

In regards of allegation of staff does not ensure water temperature was appropriate for residents. Per residents' interviews, one (1) out of nine (9) residents interviewed was attempted. Eight (8) out nine (9) residents interviewed indicated that there was no issue with water temperature. Per staff interviews, all staff were not able to corroborate the allegation. During physical plant, twelve (12) resident rooms were randomly selected, and the water temperature was measured in the range of 105-120 degrees Fahrenheit. Therefore, the water temperature was found to be within Title 22 regulation and water temperature was appropriate for residents.

In regards of allegation of staff does not maintain resident’s hygiene. Per residents' interviews, one (1) out of nine (9) residents interviewed was attempted. Eight (8) out nine (9) residents interviewed indicated that there was no issue with residents’ hygiene. Per staff interviews, all staff were not able to corroborate the allegation. All staff indicated that the facility provides a schedule for shower, laundry, and toileting.
(Report continues on LIC-9099c)

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260115123528

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: 01/22/2026

NARRATIVE

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All staff indicated that the schedule is being followed. On record reviewed, the facility keeps track of hygiene care assistance provided to residents. LPAs observed rooms to be clean, tidy, and free foul odor. Therefore, there is no preponderance evidence to show that staff is not providing hygiene assistance as needed by residents.

Based on review of observations, documents and interviews conducted, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED.

Exit interview was held with Administrator Dennis Robeniol. A copy of the report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026

LIC9099 (FAS) - (06/04)

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