198602887-11-20-2025-11-AS-UCOL-DPNN68-20251224091040

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602887
Report Date: 11/20/2025
Date Signed: 11/20/2025 05:10:44 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
07/03/2025 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20250703084105

FACILITY NAME:	SUNRISE ASSISTED LIVING OF HERMOSA BEACH		FACILITY NUMBER:	198602887
ADMINISTRATOR:	ERIC K MENSAH		FACILITY TYPE:	740
ADDRESS:	1837 PACIFIC COAST HWY		TELEPHONE:	(310) 937-0959
CITY:	HERMOSA BEACH	STATE: CA	ZIP CODE:	90254
CAPACITY:	142	CENSUS: 81	DATE:	11/20/2025
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Senior Executive Director - Cortez Jordan		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not seek medical attention for resident in care
Staff did not prevent resident from being hit at the facility by an unknown individual
Staff did not report incident to appropriate parties

INVESTIGATION FINDINGS:

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On 11/20/2025, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced continuation complaint investigation visit regarding the allegations listed above. LPA met with the Senior Executive Director, Cortez Jordan, and the purpose of the visit was explained. LPA was granted entry to the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

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 5

Control Number 11-AS-20250703084105

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: SUNRISE ASSISTED LIVING OF HERMOSA BEACH	FACILITY NUMBER: 198602887
	VISIT DATE: 11/20/2025

NARRATIVE

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Investigation consisted of the following:

On 07/09/2025, interviews were conducted, a tour of the Reminiscence Neighborhood was conducted, records were gathered. Interviews conducted consisted of 7 resident interviews [Resident 2 (R2) to Resident 8 (R8) were interviewed] and 6 staff interviews [Staff 1 (S1) to Staff 6 (S6) were interviewed]. Facility records were gathered which consisted of Resident Roster dated 07/01/2025; Personnel Report; Abuse, Neglect & Exploitation – Prevention, Reporting and Investigation Facility Policy, Unusual Incident/Injury Report dated 06/11/2025; Staff Certificates of Completion for Abuse & Neglect Prevention; and Reminiscence Neighborhood Residents Emergency Contact Information. On 07/10/2025, Witness 1 (W1) was interviewed. On 08/28/2025, Witness 2 (W2) was interviewed. On 11/20/2025, interviews were conducted, and records were reviewed. Interviews conducted consisted of 1 staff [Staff 2 (S2) was interviewed] and 7 witness interviews [Witness 3 (W3) to Witness 9 (W9) were interviewed]. Records reviewed consisted of pertinent Resident 1’s (R1) records.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 11-AS-20250703084105

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: SUNRISE ASSISTED LIVING OF HERMOSA BEACH	FACILITY NUMBER: 198602887
	VISIT DATE: 11/20/2025

NARRATIVE

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The investigation revealed the following:

Allegation: “Staff did not seek medical attention for resident in care”, it is being alleged that staff did not seek appropriate medical attention for R1. Interviews conducted with R2 to R8 revealed the following: 7 out of 7 residents denied the allegation, moreover, residents indicated that if they required medical attention staff would assist them. Interviews conducted with W1 and W3 to W9 revealed the following: 7 out of 8 witnesses denied the allegation and 1 out of 8 witnesses agreed with the allegation. Interviews conducted with S1 to S6 revealed the following: 6 out of 6 staff denied the allegation, furthermore, S1, S2, S3 and S5 indicated that R1 was assessed for medical attention by facility staff, R1’s doctor was notified and R1 received medical attention by medical providers. “Statement of Event” written by facility staff on 06/2025 revealed the following: 5 staff indicated that R1 was assessed by facility staff and R1 was taken to urgent care. Unusual Incident/Injury Report (UIR) dated 06/11/2025 revealed the following: R1 was reported to have a swollen lip and cracked tooth; R1 was evaluated by facility staff and taken to the emergency room. Fax records dated 06/08/2025 revealed the following: facility staff faxed R1’s doctor four times. Based on the department’s interviews and records reviewed this allegation is unsubstantiated. 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 unsubstantiated.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20250703084105

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: SUNRISE ASSISTED LIVING OF HERMOSA BEACH	FACILITY NUMBER: 198602887
	VISIT DATE: 11/20/2025

NARRATIVE

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Allegation: “Staff did not prevent resident from being hit at the facility by an unknown individual”, it is being alleged that R1 was hit by an unknown individual. Interviews conducted with R2 to R8 revealed the following: 7 out of 7 residents denied the allegation, moreover, residents indicated that no one has ever hit them in the facility. Interviews conducted with W1 to W9 revealed the following: 7 out of 8 witnesses denied the allegation and 1 out of 8 witnesses agreed with the allegation; 8 witnesses indicated that they have never seen a resident being physically hit by another person; W2 goes on to explain that a police investigation was conducted in the facility regarding the allegation and it was unknown if R1 was hit by an individual or if R1 fell on the corner of their coffee table, W2 explains that no individual was arrested due to the allegation and there was not sufficient evidence to indicate that an individual hit R1. Interviews conducted with S1 to S6 revealed the following: 6 out of 6 staff denied the allegation, furthermore, staff indicated that they have not seen or heard that R1 was physically hit by an individual, S1 goes on to explain that the Hermosa Beach Police came to the facility, conducted an investigation, requested video footage of the facility and sign in and sign out records of the facility. Records reviewed of the Hermosa Beach Police Department DR# 25-0001355-Crime / Incident Report dated 06/11/2025 regarding the incident with R1 revealed the following: The Hermosa Beach Police Department were unable to determine if an unknown individual hit R1 or if R1 fell. Based on the department’s interviews and records reviewed this allegation is unsubstantiated. 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 unsubstantiated.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20250703084105

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: SUNRISE ASSISTED LIVING OF HERMOSA BEACH	FACILITY NUMBER: 198602887
	VISIT DATE: 11/20/2025

NARRATIVE

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Allegation: “Staff did not report incident to appropriate parties”, it is being alleged that R1’s appropriate parties were not contacted. Interviews conducted with R2 to R8 revealed the following: 7 out of 7 residents denied the allegation, moreover, residents indicated staff contact their family members. Interviews conducted with W1 and W3 to W9 revealed the following: 7 out of 8 witnesses denied the allegation and 1 out of 8 witnesses agreed with the allegation; 7 witnesses indicated that staff contact them when necessary and W1 indicated that facility staff contacted them when R1 had an incident. Interviews conducted with S1 to S6 revealed the following: 6 out of 6 staff denied the allegation, furthermore, staff indicated that R1’s responsible person was contacted and their medical provider. S1 indicated that the facility did not submit an SOC341 Report of Suspected Dependent Adult-Elder Abuse because they did not think nor have evidence that R1 was a victim of elder abuse. Unusual Incident/Injury Report (UIR) dated 06/11/2025 revealed the following: R1 was reported to have a swollen lip and cracked tooth; R1 was evaluated by facility staff and taken to the emergency room; the UIR was faxed to the department. Based on the department’s interviews and records reviewed this allegation is unsubstantiated. 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 unsubstantiated.

No deficiencies were cited.

An exit interview was conducted, and a copy of this report was left with the Resident Care Director, Lennora Folkes.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025

LIC9099 (FAS) - (06/04)

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