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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603245
Report Date: 08/12/2025
Date Signed: 08/12/2025 11:58:06 AM

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
08/04/2025 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250804102812
FACILITY NAME:CASA MARIPOSA-DOLLARFACILITY NUMBER:
198603245
ADMINISTRATOR:DANIELS, VANESSA R.FACILITY TYPE:
735
ADDRESS:2403 DOLLAR STREETTELEPHONE:
(562) 788-7192
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:4CENSUS: 4DATE:
08/12/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:DSP Vanessa CerdaTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff do not meet a client's incontinence needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced complaint investigation regarding the above allegations. LPA was met by DSP Vanessa Cerda. Back up Administrator Elizabeth Saucier was notified by telephone.

The investigation consisted of the following: LPA Gutierrez requested and obtained copies of staff roster, client roster, client (C1) identification and emergency information, functional capability assessment, and appraisal needs and service plan. LPA conducted interview with Administrator, S2, and C1 over the telephone. LPA Interviewed S1 in person and toured facility.

SEE 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
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 28-AS-20250804102812
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: CASA MARIPOSA-DOLLAR
FACILITY NUMBER: 198603245
VISIT DATE: 08/12/2025
NARRATIVE
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In regard to the allegation” Staff do not meet a client's incontinence needs”, It is alleged that staff are not properly changing C1 and sent C1 to program in urine-soaked clothing. During interviews with Administrator and staff it was reveled that C1 did go to program with wet clothes and undergarments. Staff stated that C1 was asked to change but refused and was sent to program anyways. During interview with clients C1 stated that he/she did not want to be changed because they did not want to miss the bus.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code.

An exit interview was conducted. A copy of the report and appeal rights were provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250804102812
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: CASA MARIPOSA-DOLLAR
FACILITY NUMBER: 198603245
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
08/15/2025
Section Cited
CCR
80072(a)(2)
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80072 Personal Rights
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

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Administartor will conduct training with staff about clients personal rights and send to LPA by POC due date.
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This deficiency is evidenced by the following:'
C1 was sent to day program with urine soaked clothing and undergarments.
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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: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3