198603225-5-21-2026-28-AS-WSHO-DX4M3K-20260819091515

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603225
Report Date: 05/21/2026
Date Signed: 05/21/2026 12:32:08 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/07/2026 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260407140427

FACILITY NAME:	CRISTO REY COTTAGE ASSISTED LIVING		FACILITY NUMBER:	198603225
ADMINISTRATOR:	KLEIN, KATHRYN		FACILITY TYPE:	740
ADDRESS:	1216 ROYAL OAKS DRIVE		TELEPHONE:	(626) 408-7802
CITY:	MONROVIA	STATE: CA	ZIP CODE:	91016
CAPACITY:	28	CENSUS: 20	DATE:	05/21/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Sister Magdalene Grace		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff are not assessing residents for a higher level of care
Staff are not checking on residents in a timely manner
Untrained staff providing care to residents

INVESTIGATION FINDINGS:

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The purpose of this report today 5/21/2026 is to gather additional information pertaining to the above allegations.
The initial visit was conducted on 4/10/2026 and included the following: LPA obtained Staff and Resident Rosters.
Copies of staff and med-tech training's were submitted.
Interviews were conducted with Staff S1-Staff S4 and with Sister Cecilia Marie, Care Assistant.
Interviews were conducted with Resident's R1-R9.
At today's visit 5/21/2026 Resident's R1-R6 were interviewed. Resident's R7 and R8 refused to be interviewed. Resident's R9-R11 were interviewed.
Sister Magdalene Grace and Staff S1 were interviewed.
In regards to the allegation Staff are not assessing residents for a higher level of care, based on interviews conducted and information gathered it was revealed by 9 out of 9 residents that they were able to communicate what their name and date of birth were. While being interviewed all 9 were able to

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

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-20260407140427

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CRISTO REY COTTAGE ASSISTED LIVING	FACILITY NUMBER: 198603225
	VISIT DATE: 05/21/2026

NARRATIVE

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communicate their feelings about the staff, residents and the facility.
All stated that there are not any residents with Dementia.
Review of 9 out of 9 residents Physician's Report in which there was not dementia diagnosis listed.
Staff interviewed stated that there are no Dementia residents at this facility.
Said that all residents communicate their wants and needs.
Stated that they are all alert. Nothing on the scale of Dementia.
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.

In regards to the allegation Staff are not checking on residents in a timely manner, based on interviews conducted and information gathered it was revealed by 9 out of 9 residents that staff are wonderful and that they are always there to help them. They are very caring.
All 9 residents also stated that staff do not administer medication for them and they independently can leave the facility and walk around and it's their choice to stay in their room.
Also stated they have pendants that they can use and staff respond immediately.
All stated that staff respond in a timely manner.
Staff stated that they do respond in a timely manner.
Said they have a call lite system that is located by the residents bed and bathroom. Said it is a very efficient system that alert staff on their phones when a resident is asking for assistance. Response is very quick being that most of the residents are independent in their Activity's of Daily Living (ADL's.)
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.

In regards to the allegation Untrained staff providing care to residents, based on interviews conducted and information gathered it was revealed by 9 out of 9 residents that staff are well trained and that the food staff, caregivers and med-techs carry out their job duties very efficiently.
Staff interviewed stated that they have gone through hours of training which included shadowing other staff.
Stated that only nurses assess residents and other staff don't make a decision on residents care.
Also stated that there is an agency that comes into the facility and provides nursing care such as labs and x-rays so the resident does not have to leave. It is the family's decision.
Caregiver training reviewed which included 8 hours facility practices and procedures and 6 hours Caring for Residents with Dementia. Training document was signed by the employee, trainer and Supervisor.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260407140427

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CRISTO REY COTTAGE ASSISTED LIVING	FACILITY NUMBER: 198603225
	VISIT DATE: 05/21/2026

NARRATIVE

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Med-Tech Training was reviewed which included Special Needs of the Elderly 1 hour, Delivering Personal Care 8 hours, Psychosocial Care 2 hours, Responding to Resident Emergencies 3 hours, Caring for Residents with Dementia 6 hours, Successful Completion of all Hands on Checklists 16 hours (hands on training).Document was signed by the employee, trainer and supervisor.
Medication Administration Skills Checklist Document was implemented and signed by the employee and supervisor.
Also Rellias Training Program a software training program was completed by Staff and included Infection Control and Medication procedures.

At today's visit 5/21/2026 Sister Magdalene Grace stated that the Dementia training is covered because even if non-dementia waiver the topic should be covered.
Staff S1 stated it is helpful to cover Dementia Training so staff will be knowledgeable on signs to look for if residents have Cognitive Impairment and can recognize signs that might lead to Dementia.
Regarding Activities there is a calendar posted each month. Sister Magdalene Grace and Staff S1 both stated that at breakfast the daily activities are discussed.
Resident's R1-R6 and R9-R11 stated they get an Activity's calendar each month and it is also posted.
All stated staff discuss the activities daily at breakfast. Stated that there is exercise class, bingo, dominoes, arts and crafts and knitting.
LPA observed May 2026 Activity calendar which included exercise, painting, arts and crafts, spoon races, trivia, movie matinee, puzzle club, horseshoe toss, crosswords, roulette and coloring.

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.

Exit interview conducted and copies provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

LIC9099 (FAS) - (06/04)

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