198602625-1-15-2026-11-AS-SCIS-DQHRSF-20260120121636

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602625
Report Date: 01/15/2026
Date Signed: 01/15/2026 04:07:53 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
08/28/2025 and conducted by Evaluator Felisa Shirley

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250828085333

FACILITY NAME:	SHERMAN RESIDENTIAL CARE		FACILITY NUMBER:	198602625
ADMINISTRATOR:	SHERETT D RENEAU		FACILITY TYPE:	735
ADDRESS:	5322 THIRD AVE		TELEPHONE:	(323) 815-9880
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90043
CAPACITY:	4	CENSUS: 3	DATE:	01/15/2026
		UNANNOUNCED	TIME BEGAN:	03:41 PM
MET WITH:	Stacy Gadsden, House Manager		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff mismanaged client’s medication
Staff did not ensure that client’s prescribed equipment was properly maintained
Staff did not follow client’s physician orders in a timely manner
Staff did not provide adequate linens to client in care
Staff did not provide adequate clothing to client in care
Staff did not coordinate with the regional center staff resulting in the client not receiving appropriate services

INVESTIGATION FINDINGS:

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* This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 9/15/25.

On 1/15/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by House Manager, Stacy Gadsden and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility.

The investigation consisted of the following:
On 9/4/25 LPA Shirley reviewed copies of the following records: Client file, Staff and Client Roster, Client Face Sheet, Resident Appraisal, Functional Capability Assessment, Identification and Emergency Information, Physician’s Report, Appraisal/Needs and Services House Rules, Client Persnal Property and Valuables list, Vision Essentials receipts, Special Incident Report, Daily Notes, IPP, IPP Addendum, Initial Behavior Assessment and Behavior Intervention plan, Client Development Evaluation Report, Regional Document, Whole Person Assessment, After Visit Summary, Physician Order, Facility Batch Report, CSMDR, Medication Descriptions, and Medication Administration Records 2/25 thru 9/2025. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff-6 (S1 – S6), and Client – 1 – Client -3 (C1-C3)).
Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250828085333

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: SHERMAN RESIDENTIAL CARE	FACILITY NUMBER: 198602625
	VISIT DATE: 01/15/2026

NARRATIVE

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The investigation revealed the following:

Allegation: Staff mismanaged client’s medication.

It was reported that Lithium Carbonate was restarted without the responsible person’s knowledge. Per review of Medication Administration Records, (MAR), 2/25 thru 9/25, LPA observed that Lithium Carbonate 300mg was not administered to C1 from 4/1/25 thru 7/30/25. Upon further review, LPA Shirley observed that Lithium Carbonate 300 mg was resumed effective 7/31/25 thru 9/4/25. LPA Shirley observed the After Visit Summary of C1’s visit to Kaiser on 7/29/25 and 7/30/25. The responsible person was not present at these appointments. The summary stated that Lithium Carbonate 300 mg was restarted by the doctor and was relevant to this visit on 7/30/25.

LPA interviewed staff 1 – staff 6 (S-1 – S-6). Of those interviewed 6 out of 6 denied the allegation. LPA interviewed client 1 – client 3 (C-1 – C-3), of which 2 denied the allegation and 1 confirmed it.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff mismanaged client’s medication.” therefore, the allegation is unsubstantiated.

Allegation: Staff did not ensure that client’s prescribed equipment was properly maintained.

It was reported that C1’s glasses were not properly maintained. Per file review, LPA Shirley observed a Special Incident Report dated 7/3/25, in which C1 was accompanied by 2 staff members to his optometry appointment. Upon entry into the lobby of the building, C1 punched S6 in the face 3 to 4 times and struck an elderly lady who was exiting the building. The Sheriff Department came out and transported C1 to Centinela Hospital. C1 never made it to the appointment. LPA Shirley reviewed vision prescription from rescheduled app on 7/23/25. The glasses were ordered on 7/24/25 per the receipt, ready on 8/16/25 and they were picked up on 8/18/25.

LPA interviewed staff 1 – staff 6 (S-1 – S-6). Of those interviewed 6 out of 6 denied the allegation. LPA interviewed client 1 – client 3 (C-1 – C-3), in which 2 denied the allegation and 1 was not sure.

Con'd on 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250828085333

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: SHERMAN RESIDENTIAL CARE	FACILITY NUMBER: 198602625
	VISIT DATE: 01/15/2026

NARRATIVE

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Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not ensure that client’s prescribed equipment was properly maintained,” therefore, the allegation is unsubstantiated.

Allegation: Staff did not follow client’s physician orders in a timely manner.

It was reported that staff did not comply with physician’s order for corrective shoes and braces for C1. Upon review of the House Rules which were signed by C1, LPA observed that clothing must be provided by the resident or the resident’s representative. This includes underclothing, night wear and shoes that fit properly. During interviews with Administrator, C1 attended the doctors appointment for corrective shoes and following that appointment, C1’s responsible party sent basic gym shoes. On 9/4/25, the Administrator stated that C1’s orthodontic treatment for braces, was complete. C1’s responsible party took him to be fitted for retainers. C1 stored his own retainers. It was reported that staff delayed compliance with a physician’s order for a more supportive bed. LPA Shirley reviewed C1’s facility file and did not observe a physician’s order for a bed. Per interview with the Administrator, C1’s family member purchased a mattress for the client in care.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not follow client’s physician orders in a timely manner,” therefore, the allegation is unsubstantiated.

Allegation: Staff did not provide adequate linens to client in care.

It was reported that the facility staff failed to provide adequate linens for C1. On 9/4/25, LPA Shirley toured the facility and observed that all 3 clients had adequate linens and bedding. LPA Shirley observed that clients’ linens were kept in their room’s designated storage. Per interview with a family member, she purchased a

Con'd on 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20250828085333

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: SHERMAN RESIDENTIAL CARE	FACILITY NUMBER: 198602625
	VISIT DATE: 01/15/2026

NARRATIVE

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a comforter set with lively colors as she did not want the room to appear to be drab. During interviews with the Administrator, C1 has 4 different sets of linens for his assigned room. LPA Shirley reviewed the House rules which stated that personal furniture is permitted if space allows and with the manager’s approval.

LPA interviewed staff 1 – staff 6 (S-1 – S-6). Of those interviewed 6 out of 6 denied the allegation. LPA interviewed client 1 – client 3 (C-1 – C-3), who denied the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not provide adequate linens to client in care,” therefore, the allegation is unsubstantiated.

Allegation: Staff dd not provide adequate clothing to client in care.

It was reported that the facility staff are not providing adequate clothing to C1. On 9/4/25, LPA Shirley reviewed the Client/Resident Personal Property and Valuable list, which upon admission, C1 had a substantial amount of clothing. On 9/4/25, LPA Shirley observed C1 as he came into the facility’s dining room to put in his request for lunch. The client was observed wearing an appropriately sized t-shirt and sweatpants. Upon review of the House Rules which were signed by C1, LPA observed that clothing must be provided by the resident or the resident’s representative. This includes underclothing, night wear and shoes that fit properly.

LPA interviewed staff 1 – staff 6 (S-1 – S-6). Of those interviewed 6 out of 6 denied the allegation. LPA interviewed client 1 – client 3 (C-1 – C-3), who all denied the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not provide adequate clothing to client in care,” therefore, the allegation is unsubstantiated.

Allegation: Staff did not coordinate with the regional center staff resulting in the client not receiving appropriate services.

Con'd on 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20250828085333

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: SHERMAN RESIDENTIAL CARE	FACILITY NUMBER: 198602625
	VISIT DATE: 01/15/2026

NARRATIVE

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It was reported that the responsible party had to personally enroll C1 in school and is requesting a one-on-one behaviorist. LPA Shirley reviewed an Order appointing Limited Conservatorship court documents for C1. Per interview with Regional Representative, LPA was told that if a client has a conservator, that person is responsible for enrolling the client into school. If the client were not conserved, the administrator is responsible for enrolling that client into school. Family is requesting a one-on-one Behaviorist for C1. Per LPA’s interview on 9/11/25 with the Service Coordinator, if a client is residing in an Adult Residential Facility, there is one Behaviorist assigned to all clients within that facility. The Administrator stated that she was told by the Behaviorist and Service coordinator that is was suggested that the responsible party investigate options for one-on-one services.

LPA interviewed staff 1 – staff 6 (S-1 – S-6). Of those interviewed 6 out of 6 denied the allegation. LPA interviewed client 1 – client 3 (C-1 – C-3), who all denied the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not coordinate with the regional center staff resulting in the client not receiving appropriate services,” therefore, the allegation is unsubstantiated.

No deficiencies were cited for these allegations.

An exit interview was conducted and a copy of this report was provided to House Manager, Stacy Gadsden.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

LIC9099 (FAS) - (06/04)

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