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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602406
Report Date: 07/30/2026
Date Signed: 07/30/2026 12:09:22 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2026 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 11-AS-20260722135317
FACILITY NAME:ALABASTER ELDERLY CAREFACILITY NUMBER:
198602406
ADMINISTRATOR:DAVIS, DELORESFACILITY TYPE:
740
ADDRESS:9825 8TH AVENUETELEPHONE:
(323) 971-2964
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY:6CENSUS: 5DATE:
07/30/2026
UNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Delores DavisTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
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9
Staff do not safeguard resident's personal belongings.
Staff did not administer medication as prescribed.
INVESTIGATION FINDINGS:
1
2
3
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6
7
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9
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13
On July 30, 2026, Licensing Program Analyst (LPA) Antonine Richard conducted a follow-up complaint visit to the facility above. During the visit, LPA Richard met Administrator (A1) Delores Davis, who was informed about the purpose of the visit.

The investigation included a request for several documents, such as the staff roster, resident roster, documents related to Resident 1 (R-1), the admission agreement, physician report, Medication Administration Records (MAR), the California General Durable Power of Attorney, Revocation of Power of Attorney, Advance Health Care Directive Form, records of resident personal property and valuables, daily adjournment sheets, and Serious Incident Reports (SIR). LPA Richard interviewed five residents (R2-R6), three staff members (S1-S3), the Administrator (A1), and the Power of Attorney (POA). Resident (R1) moved out of the facility on July 23, 2026.

Report continued on LIC9099C.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
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 4
Control Number 11-AS-20260722135317
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: ALABASTER ELDERLY CARE
FACILITY NUMBER: 198602406
VISIT DATE: 07/30/2026
NARRATIVE
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Allegation: #1: Staff do not safeguard resident’s personal belongings.

The complaint alleged that the Power of Attorney (POA) and another individual took the resident’s ID and bank cards under the pretense of preventing theft. On July 28, 2026, the Licensing Program Analyst (LPA) Richard interviewed the Administrator (A1), who denied the allegations. A1 stated that when the resident was admitted to the facility, no bank cards were recorded as personal belongings.

During the same investigation, the department interviewed three staff members (S1-S3), all of whom also denied the allegations, claiming they were unaware of any resident's bank cards. Additionally, the LPA spoke with five residents (R2-R6); three out of 5 expressed that they enjoyed living at the facility.

The LPA interviewed the Power of Attorney (POA), who denied the allegations and stated that the resident (R1) has access to R1's bank card. The LPA also reviewed records of the resident's personal property and valuables dated July 3, 2026, at the time of R1's admission to the facility. The records did not list any bank cards. On July 23, 2026, during R1's move-out, personal property and valuables were taken; no bank card was listed. The LPA also reviewed the facility's unusual incident report to the Community Care Licensing Department regarding R1's move-out with a family member. However, on July 28, 2026, the LPA was unable to interview resident R1 because R1 had moved out of the facility on July 23, 2026, and their current whereabouts are unknown.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur; therefore, the allegation is unsubstantiated.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20260722135317
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: ALABASTER ELDERLY CARE
FACILITY NUMBER: 198602406
VISIT DATE: 07/30/2026
NARRATIVE
1
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3
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5
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Allegation #2: Staff did not administer medication as prescribed.

The complaint alleged that staff provided inadequate daily assistance and routinely failed to administer R1's prescribed blood pressure medication. On July 28, 2026, LPA Richard interviewed the Administrator (A1), who denied the allegations. The Administrator stated that staff measured blood pressure twice daily and assisted R1 with blood pressure medication. The Administrator also noted that R1 was aware of all medications and knew when to take them.

On July 28, 2026, the LPA interviewed three staff members (S1-S3), all of whom also denied the allegations. They confirmed that they took the resident's blood pressure twice a day and ensured it remained at safe levels.

The LPA also interviewed five residents (R2-R6) on the same day, and three of five reported that staff helped them. Furthermore, the Power of Attorney (POA) for resident R1 denied the allegations, stating that facility staff took good care of R1 and that the POA had no concerns about the quality of care R1 received while living in the facility.

During the investigation, the LPA reviewed the Medication Administration Record (MAR), which showed that staff documented the administration of R1's blood pressure medication each time it was given. The LPA also examined the facility's daily adjournment sheet, which indicated that R1's vital signs were taken twice daily from July 4, 2026, to July 22, 2026. Unfortunately, when R1 moved out of the facility, R1 took all medications with them. The LPA was unable to compare the actual blood pressure medication with the MAR.

Report continued on LIC9099C.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20260722135317
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: ALABASTER ELDERLY CARE
FACILITY NUMBER: 198602406
VISIT DATE: 07/30/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
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12
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15
16
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31
32
Upon reviewing the facility records, on July 28,2026, the LPA found no discrepancies in the MAR regarding blood pressure medication. However, on July 28, 2026, the LPA was unable to interview resident R1 because R1 had moved out of the facility on July 23, 2026, and their current whereabouts are unknown.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur; therefore, the allegation is unsubstantiated.

No deficiencies were cited.

An exit interview was conducted. A copy of this report was provided to Administrator Delores Davis.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4