198603162-5-1-2026-28-AS-DSIS-DTUQY5-20260507123434

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 05/01/2026
Date Signed: 05/01/2026 03:52:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
07/17/2025 and conducted by Evaluator Erik Zaragoza

COMPLAINT CONTROL NUMBER: 28-AS-20250717142605

FACILITY NAME:	WHITTIER GLEN ASSISTED LIVING		FACILITY NUMBER:	198603162
ADMINISTRATOR:	BARBA AGUIRRE, ITZAYANA		FACILITY TYPE:	740
ADDRESS:	10615 JORDAN RD		TELEPHONE:	(562) 943-3724
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	93	CENSUS: 83	DATE:	05/01/2026
		UNANNOUNCED	TIME BEGAN:	10:49 AM
MET WITH:	Itzayana Barba-Aguirre - Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Questionable death
Staff abandoned resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent complaint visit to deliver the findings of the investigation. LPA met with Itzayana Barba-Aguirre, administrator for the facility, and explained the purpose of the visit.

The complaint consisted of the following: On the initial visit condcuted on 7/18/2025 conducted by Tena Herrera, LPA obtained copies of Staff/Resident Roster, and toured facility. On a subsequent visit conducted on 8/4/2026, LPA Zaragoza interviewed Residents #2 - 9 (R2 - R9), Staff #1 - 4 (S1 - S4), and obtained the admissions agreement, FACE Sheet, facility discharge paperwork, physician's report, appraisals, and service plan for Resident #1 (R1). Since the visit LPA Zaragoza attempted to gain physician orders for R1, obtained a physical report from R1's previous placement to the facility and also the transportation policy for the facility. . Since the visit on 8/4/2025, LPA Zaragoza also interviewed Staff #5 and Staff #6 (S5 - S6). Between the dates of 7/18/2025 - 11/5/2025, Investigations Branch (IB) investigator Real interviewed S6, Witnesses #1 - 2 (W1 - W2), and also obtained the death certificate for R1. [CONT. on LIC9099-C page.]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

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 7

Control Number 28-AS-20250717142605

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
	VISIT DATE: 05/01/2026

NARRATIVE

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IB investigator Real attempted to interview R1 and Staff #7 (S7), however was unable to because they are both deceased. During today's visit, LPA Zaragoza will be delivering the findings of the investigation.

The investigation revealed the following: In regards to the allegation of "Questionable death," it is alleged that R1 passed away on 4/18/2022 due to staff neglect, because R1 had been dropped off at a bus station by S7, and ultimately did not get on the bus which led to their passing. During interviews conducted by IB, it was revealed that a plan was put in place for R1 to travel to Iowa to live with W1, however R1 never got on the bus to arrive at their destination. During interview with S6, they stated that a plan was put in place for R1 to travel by bus to Iowa to live with W1, and all parties agreed to the plan. S6 stated that R1 was to travel by Greyhound bus with R1's trip beginning in California on 3/21/2022, and arriving on 3/23/2022. During interview with W1, they stated went to the Iowa bus station on 3/23/2022 to pick up R1 but they never arrived. W1 stated that about a month later they were notified that R1 was found deceased in Los Angeles. It was determined that R1 did not notify any party of their change in plan to not board the bus. During interview with W2, housing coordinator for R1, they stated that Whittier Glen Assisted Living did notify them of R1's discharge from the facility as required. During record review of R1's death certificate, the cause of death is listed as an accidental drug overdose.

In regards to the allegation that "Staff abandoned resident," it is alleged that R1 was abandoned at the bus station because R7 did not ensure that R1 had boarded the bus to travel to Iowa. During interviews conducted by IB, it was revealed that S7 did transport R1 to the bus station for their planned travel to Iowa. During interview with S6, they stated that after S7 did drive R1 to the bus station and made sure that R1 had their tickets to make the travel. S6 stated that S7 left the victim waiting for the bus at the station and returned to the facility. During interview with W1, they stated that they were not comfortable with R1 travelling by themselves to Iowa, but they plan was made anyway, and R1 never arrived at the bus station in Iowa as planned on 3/23/2022. During record review of the facility's transportation policy for scheduled transportation that "unfortunately, the driver may not wait for the resident." Therefore it was determined the facility did not deviate from their plan of operation.

Based on statements and interviews conducted with staff, residents, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
07/17/2025 and conducted by Evaluator Erik Zaragoza

COMPLAINT CONTROL NUMBER: 28-AS-20250717142605

FACILITY NAME:	WHITTIER GLEN ASSISTED LIVING		FACILITY NUMBER:	198603162
ADMINISTRATOR:	BARBA AGUIRRE, ITZAYANA		FACILITY TYPE:	740
ADDRESS:	10615 JORDAN RD		TELEPHONE:	(562) 943-3724
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	93	CENSUS: 83	DATE:	05/01/2026
		UNANNOUNCED	TIME BEGAN:	10:49 AM
MET WITH:	Itzayana Barba-Aguirre - Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not ensure residents plan of care was followed
Staff did not ensure resident was provided medications
Staff did not ensure reporting requirements were followed

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

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

LIC9099 (FAS) - (06/04)

Page: 3 of 7

Control Number 28-AS-20250717142605

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
	VISIT DATE: 05/01/2026

NARRATIVE

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for the allegation "Staff did not ensure residents plan of care was followed." IB investigator Real attempted to interview R1 and Staff #7 (S7), however was unable to because they are both deceased. During today's visit, LPA Zaragoza will be delivering the findings of the investigation.

In regards to the allegation that "Staff did not ensure residents plan of care was followed," it was alleged that R1 had lacked capacity and not allowed to leave the facility without assistance according to their physician report, however the facility proceeded with allowing R1 to travel three (3) days by bus to Iowa on their own to live with W1 in March of 2022. During interviews conducted by IB, it was determined that R1 was allowed to travel by themselves to Iowa. During interviews with S6, they stated that according to their appraisal of R1, they displayed a high cognitive level, and did not display any memory related issues during his assessment. S6 stated that R1 was able to communicate their own needs, ambulate on their own with assistant at times, however they were “pretty independent while walking.” During interview with W1, they stated that R1 lost the use of is hand or arm and would forget who they were talking to occasionally. During record review of R1's physician's report, it does indicate that they were unable to leave the facility unsupervised and required supervision.

In regards to the allegation that "Staff did not ensure resident was provided medications," it is alleged that R1 was a diabetic who required insulin medication, however they were not provided any of their medications when they were taken to the bus station to relocate to live with W1. During interviews with residents conducted by LPA Zaragoza on 8/4/2025, three (3) out of eight (8) corroborated the allegation. One resident stated that they do not receive their medications on time by staff. Another resident interviewed stated that they need to ask staff for their medications during medication passes or else don't receive them. During interviews with staff, none of them corroborated the allegation. S6 stated that R1 never required insulin or had a physician's order for it, and that is why they were not provided insulin as part of their travel to Iowa. Another staff interviewed stated that they also did not work at the time R1 lived in the facility, however when residents are going out or discharged, they do provide medications to the residents and also document the medications that were provided on a medication release form as proof. During record review of R1's physician report dated 1/27/2022, it describes that R1 was not able to administer their own medications or injections, and that they had a diabetes diagnosis with two (2) different types of insulin listed for their medication/treatment of their diabetes. LPA requested medication records for R1 from the facility, however there is nothing on record.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 7

Control Number 28-AS-20250717142605

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
	VISIT DATE: 05/01/2026

NARRATIVE

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In regards to the allegation that "Staff did not ensure reporting requirements were followed," it is alleged that following R1 did not arrive at their planned destination in Iowa to live with W1 on 3/23/2022 and their passing on 4/18/2022, the facility did not notify Community Care Licensing Division (CCLD) or the law enforcement of these incidents. During interviews with staff, one (1) out of six (6) corroborated the allegation. During interview with S6 who was the administrator of the time, they admitted that they were aware that R1 did not arrive at their destination in Iowa as planned, because they did remain in communication with W1 during this time. Another staff member interviewed who presently works at the facility stated that whenever a resident has an absence or passes away, they always report it to the licensing agency. During record review of incident reports for the facility in 2022, LPA did not discover any incident reports related to the missing status or death for R1.

Based on LPA interviews conducted with the residents and staff, the preponderance of evidence standard has been met for the above allegations, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 8 is being cited on the attached LIC9099-D page.

Exit interview was held and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 28-AS-20250717142605

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/01/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/02/2026 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	(a) In addition to (...) residents (...) shall have the following personal rights. (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This regulation is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator is to ensure that all residents are provided care and supervision to meet their individual need at all times. Administrator shall submit the facility's plan on how all residents care plans will be adhered to by the POC due date.
	8 9 10 11 12 13 14	Based on record review and interview, the facility did not meet the above requirement in one (1) out of nine (9) residents, because R1 was unable to leave the facility unassisted and was allowed to travel on ther own by bus without a responsible adult to assist them, which posed an immediate health and safety risk to resident in care.	8 9 10 11 12 13 14
Type A 05/02/2026 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	(a) A plan for the indicental medical and dental care shall be developed (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This regulation is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator is to ensure that all residents are assisted with self-administered medications as needed at all times. Administrator shall submit a plan to ensure that all the residents' are assisted with their self-administered medications and injections to LPA by the POC due date.
	8 9 10 11 12 13 14	Based on interview and record review, the facility did not meet the above requirement in four (4) out of nine (9) residents, because R1 required insulin based on available documentation and no evidence was provided that they were provided it, along with corroborations from R2 - R4. Which poses/posed an immediate health and safety risk for residents in care.	8 9 10 11 12 13 14

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: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 28-AS-20250717142605

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WHITTIER GLEN ASSISTED LIVING	FACILITY NUMBER: 198603162
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/01/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/22/2026 Section Cited CCR 87211(a)(1)(D)	1 2 3 4 5 6 7	(a) Each licensee shall furnish to the licensing agency such reports (...) including (...) the following. (1) A written report (...) within seven days of the occurrence (...) and disposition of the case. (D) Any incident which threatens the welfare, safety (...) or unexplained absence of the resident.	1 2 3 4 5 6 7	Licensee/Administrator is to ensure that all incident and death reports are to be submitted to the licensing agency within the appropriate timeframe at all times. Administrator shall submit a plan on how the facility will ensure all incident reports are reported timely to LPA by the POC due date.
	8 9 10 11 12 13 14	This regulation is not met as evidenced by: Based on interview and record review, the facility did not meet the above requirement in 1 out of 9 residents. Because an incident report was not submitted following R1's absence and death, which posed a potential health and safety risk to residents 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: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026

LIC9099 (FAS) - (06/04)

Page: 7 of 7