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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602996
Report Date: 03/19/2025
Date Signed: 04/16/2025 09:23:22 AM

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
03/12/2025 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250312141127
FACILITY NAME:SAR ADULT HOME CAREFACILITY NUMBER:
198602996
ADMINISTRATOR:SAR, VASHNAFACILITY TYPE:
735
ADDRESS:926 E 163RD STTELEPHONE:
(424) 403-4063
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:4CENSUS: 3DATE:
03/19/2025
UNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Vashna SarTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Unlawful eviction.
Staff stole resident’s money.
INVESTIGATION FINDINGS:
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On 3/19/25, at 9:30am, the department conducted an initial complaint visit to the facility and was greeted by Vashna Sar, Administrator. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff/clients, and deliver findings for the allegations mentioned above.

The investigation consisted of the following: An initial complaint visit was completed by the department on 03/19/25. A subsequent visit was completed by the department on 04/16/25. The department investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S2) and clients (C1-C3) from 10:00am-2:00pm. The department received the following: Client Roster (Dated: 01/16/2025), Staff Roster (Dated: 11/01/2024), Physicians Report (Dated: 1/04/24), Pre-Placement Appraisal (Dated: 1/12/24), Admission Agreement (Dated: 1/12/24), Face Sheet (Dated: 2/13/24), South Central Los Angeles Regional Center Accounting Letter (Dated: 10/11/2024), SCLARC Medication Returned Letter (Dated: 10/18/2024), Individual Program Plan (Dated: 11/02/2023), Client/Resident Personal Property And Valuables (Dated: 10/17/2024), Eviction Notice (Dated: 09/04/2024), P & I Ledger (Dated: 04/09/2024-10/10/2024), Special Incident Report (Dated: 10/02/2024) ...

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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
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 11-AS-20250312141127
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: SAR ADULT HOME CARE
FACILITY NUMBER: 198602996
VISIT DATE: 03/19/2025
NARRATIVE
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SCLARC Informal Conference Form (Dated: 11/01/2024), Text Message Chain (Dated:08/29-09/2024) and Email Documents (Dated: 09/04/2024-10/01/2024), from the facility.

The investigation revealed the following: Allegation #1- Unlawful Eviction.

The details of the complaint alleged that the facility did not give the former client a 30-day eviction notice, prior to being told they had to leave. On 3/18/25, at 2:57pm, the department interviewed former client (C1) and on 3/19/25, from 10:00am-2:00pm, the department interviewed staff (S1-S2) regarding the allegation. Former client (C1) denies that the facility ever gave them an eviction notice. Staff (S1-S2) denied the allegation that the facility gave an Unlawful Eviction to the client. All Staff (S1-S2) stated that the client was aware of the eviction and was given notice on 09/04/2024 and left on 10/17/2024. Staff also stated that they found the eviction notice crumpled up and thrown in the trash can in the client’s room. Additionally, stated staff, the South-Central Los Angeles Regional Center was sent a copy of the notice, as well as Community Care Licensing on the same day. Staff stated that the regional center tried to find other placement facilities for the client, but the client would always miss the scheduled meetings.

The department reviewed the eviction notice (Dated: 09/04/2024), Special Incident Report (Dated: 10/02/2024), SCLARC Informal Conference Form (Dated: 11/01/2024) and Email Documents (Dated: 09/04/2024-10/01/2024) regarding the eviction. The documentation reviewed verifies that the South-Central Los Angeles Regional Center, Community Care Licensing Division, and the client new of the pending eviction.

A review of the eviction notice revealed that (C1) was issued a 30-day eviction notice for non-compliance with facility house rules, causing a hostile home environment for clients in care, and disrupting daily operations of the facility. The department also observed that the regional center was notified on 09/04/24 of the eviction and was in the process of setting up (C1) with Supportive Living Services. The department further observed that Community Care Licensing Division was made aware of the eviction and that all components of the eviction letter were included per Title 22 regulations.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the facility issued an Unlawful Eviction. 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.

Allegation #2- Staff stole resident’s money.

The details of the complaint alleged that the facility administrator stole the former client’s money by making themselves the payee and transferring the money into their personal account. On 3/19/25, from 10:00am-2:00pm, the department interviewed staff (S1-S2) and clients (C1-C3) regarding the allegation. Staff (S1-S2) denied the allegation that the Staff stole resident’s money. All staff (S1-S2) stated that the facility has never stolen any money from the client. They further state that the client had problems getting their P & I money before they came to the facility.

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SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250312141127
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: SAR ADULT HOME CARE
FACILITY NUMBER: 198602996
VISIT DATE: 03/19/2025
NARRATIVE
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And eventually their problems with social security were resolved and that South Central Los Angeles Regional Center (SCLARC) was the payee, and not the facility administrator. Staff stated at no time did any money of the client, go into their personal account.

The department interviewed clients (C1-C3) about the allegation and 2 of 3 clients that were interviewed denied the allegation that Staff stole resident’s money. The majority of the clients (2 of 3) stated that they have not had any problems with theft in the facility and that they do receive all money that is due to them.

The department reviewed the Admission Agreement (Dated: 1/12/24), P & I Ledger (Dated: 04/09/2024-10/10/2024), South Central Los Angeles Regional Center Accounting Letter (Dated: 10/11/2024), and SCLARC Informal Conference Form (Dated: 11/01/2024). The department reviewed South Central Los Angeles Regional Center Accounting Letter (Dated: 10/11/2024) that states the client was placed at the facility in January of 2024, SCLARC started receiving the clients benefits in the month of June 2024 which was paid to the facility toward the clients’ board and care and left a balance owing the facility.

The client did not receive any P & I due to the amount they were receiving, the client continued to receive regular benefits for the month of July and August. In the latter part of August, a back payment was received from social security which allowed SCLARC, the payee, to pay the shortage of the board and care for the following months of June, July, & August, along with the P & I for June, July, & August. As of October 11, 2024, the accounting letter states the clients’ benefits have been paid in full.

The department also reviewed the P & I Ledger (Dated: 04/09/2024-10/10/2024) and observed that the client acknowledges payments received by dating and signing the form. Finally, the department reviewed the SCLARC Informal Conference Form (Dated: 11/01/2024) and observed that all allegations relating to theft and withholding of money was investigated and found not supported.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff stole resident’s money. 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 citations were issued.

An exit interview was conducted with Vashna Sar, Administrator, and a hard copy of this Complaint Investigation Report was provided.

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SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3