198603162-5-5-2026-28-AS-FFIS-DUJ2CF-20260528171640

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603162
Report Date: 05/05/2026
Date Signed: 05/05/2026 06:26:22 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
04/27/2026 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260427140812

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: 91	DATE:	05/05/2026
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Itzayana Aguirre, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff are not meeting residents’ needs in a timely manner.
Facility staff are not providing the resident medications as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegations listed above. LPA met with the administrator Itzayana Aguirre and informed the purpose of the visit.

LPA obtained copies of the staff and resident rosters, facility’s call history reports, and documents for Resident #1. LPA also reviewed medications and interviewed staff and residents.

The investigation revealed the following:
Allegation – Facility staff are not meeting residents’ needs in a timely manner. It is alleged that the residents’ needs are not adequately met and the staff response time is too long. LPA interviewed five (5) Staff. Staff indicated that they would try to tend to residents as soon as they can when they press the pendant for assistance. The med tech would also assist the residents when care staff cannot get to the residents right away.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

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-20260427140812

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

NARRATIVE

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LPA interviewed eight (8) residents. Four (4) out of the eight (8) residents stated that the staff could take as long as 15 minutes to 1 hour before they respond to their calls. Residents feel that the facility could use more caregivers since there are many residents at the facility. LPA obtained a copy of the facility’s call history from 5/1/26 – 5/5/26, and the reports show that the residents’ calls were acknowledged within a few seconds to over an hour. Based on the information gathered, this allegation is substantiated.

Allegation - Facility staff are not providing the resident medications as prescribed. LPA interviewed the administrator and medication aides regarding this allegation. Staff stated that they are administering medication within the time frame for the morning, noon, evening, and bedtime. Staff refill the medications before they run out. Staff will use the electronic medication administration record (MAR) when the medication is given to the resident. LPA reviewed nine (9) residents’ medications. LPA observed a discrepancy for Resident #1, whose medication (Baclofen 20mg) was not given today. Staff provided an order for the medication to be prescribed for 10 days. The order began on 4/26/26 and the last pill should have been given this morning on 5/5/26. However, the medication was not marked as given today. Although residents interviewed stated that they are being given their medications as prescribed, an error was found during the review. Therefore, this allegation is deemed substantiated.

Based on LPA observations, interviews conducted, and record review, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 8), are being cited on the attached LIC 9099D.

An exit interview was conducted. The Plan of Corrections were reviewed and developed with the administrator. A copy of this report and appeal rights were provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260427140812

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

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/06/2026 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The licensee shall submit a plan to ensure that all the residents' medications are present and refills are obtained. The plan is due by 5/6/26.
	8 9 10 11 12 13 14	Based on observation and record review, the medication for Resident #1 was not administered today which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
Type B 05/12/2026 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements - General(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The licensee shall develop a plan to provide sufficient staffing to ensure residents' needs are met in a timely manner. The plan is due to LPA by 5/12/26.
	8 9 10 11 12 13 14	Based on interview and record review, the facility did not employ sufficient caregivers to assist residents with their needs timely which poses a potential health, safety, and personal rights risk to 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: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

LIC9099 (FAS) - (06/04)

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