198603122-6-26-2026-28-AS-FFIS-DVMV8U-20260703161319

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603122
Report Date: 06/26/2026
Date Signed: 06/26/2026 01:39:56 PM

Substantiated

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
06/01/2026 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260601091210

FACILITY NAME:	JASMINES RESIDENTIAL CARE FOR ELDERLY		FACILITY NUMBER:	198603122
ADMINISTRATOR:	MAGHIRANG, LEVITA H		FACILITY TYPE:	740
ADDRESS:	10407 PAYETTE DR		TELEPHONE:	(562) 943-3054
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	6	CENSUS: 5	DATE:	06/26/2026
		UNANNOUNCED	TIME BEGAN:	01:04 PM
MET WITH:	Levita Maghirang		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not report incident to appropriate parties.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 06/26/2026 regarding the above allegation. On 06/04/2026, LPA Ramirez conducted an initial complaint investigation visit and a need for further investigation was documented. During today’s visit LPA Ramirez was greeted by Levita Maghirang and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez conducted Staff interviews#1- 3 (S1-S3), Witness#1-2 (W1-W2), attempted resident interview# 1, 3,5 (R1, R3, R5), resident interview#2, 4 (R2, R4) and physical plant tour.

See 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026

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 28-AS-20260601091210

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: JASMINES RESIDENTIAL CARE FOR ELDERLY	FACILITY NUMBER: 198603122
	VISIT DATE: 06/26/2026

NARRATIVE

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The investigation revealed the following: regarding the allegation “Staff did not report incident to appropriate parties.” It is alleged that facility staff did not report an incident regarding R1 to R1’s responsible party. Record review of R1’s resident file revealed that R1 was admitted into the facility on 05/21/2026 and was receiving hospice care. Review of R1’s admission agreement revealed that R1’s family is the responsible party on record. Interview of S1 revealed that on 05/23/2026, around 7:40 am, R1’s vitals were dropping and S1 called S3 to inform them about R1’s vitals. Interview of S3 revealed that they called R1’s hospice team on 05/23/2026 at 7:45 am to advise them that R1’s vital were dropping and they needed to come see R1. S1, S2 and S3 revealed that they did not contact R1’responsible party to advise them that R1 had a change in condition. Interview of S3 revealed that they did not contact R1’s responsible party to advise them of R1’s change of condition around 7:40 am. Interview of W1 revealed that they contacted R1’s responsible party around 11am to update them on R1’s condition. Interview with W2 revealed that they treated R1 on 05/22/2026 at around 11pm and were allowed entry into the facility without issues. Three (3) out of the three (3) staff interviewed corroborated this allegation. Interview with witness#1 (W1) corroborated this allegation.

Based on LPAs record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are cited on the attached LIC 9099D. Exit interview was conducted and a copy of this report, 9099-D and appeals rights were provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260601091210

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: JASMINES RESIDENTIAL CARE FOR ELDERLY	FACILITY NUMBER: 198603122
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/26/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/27/2026 Section Cited CCR 87468.1(a)(8)	1 2 3 4 5 6 7	Personal Rights Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (8) To have their representatives regularly informed by the licensee of activities related to care or ervices, including ongoing evaluations,	1 2 3 4 5 6 7	The licensee will draft a plan that will discuss how residents representatives will be regularly informed by the licensee regarding activities related to a resident’s care services, including ongoing evaluations, as appropriate to their needs. Plan must be received via email.
	8 9 10 11 12 13 14	as appropriate to their needs. This requirement was not: Licensee did not call R1's responsible party to inform them of R1's change of condition on 05/23/2026 at 7:40am. This poses an immediate risk to the health, safety, or personal rights of persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026

LIC9099 (FAS) - (06/04)

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