198603276-3-4-2025-28-AS-TVAO-DEFVLG-20250304153155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603276
Report Date: 03/04/2025
Date Signed: 03/04/2025 10:17:42 AM

Substantiated

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
02/27/2025 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250227113642

FACILITY NAME:	YEARLING BOARD AND CARE		FACILITY NUMBER:	198603276
ADMINISTRATOR:	TANGONAN, MARIA ISABEL		FACILITY TYPE:	740
ADDRESS:	11439 YEARLING CIRCLE		TELEPHONE:	(562) 307-7668
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY:	6	CENSUS: 4	DATE:	03/04/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Connie Duldulao (S-1) Isabel Tangonan (Administrator)		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Licensee is not ensuring that resident's representative has prompt access to review resident's records.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial visit to investigate the above allegation. LPA was allowed entry by Connie Duldulao (S-1). LPA discussed the purpose of today’s visit. Isabel Tangonan (Administrator) arrived at approximately 8:55 A.M..

During this investigation, LPA obtained a copy of the resident and staff rosters and interviewed S-1 and Facility Administrator.

Allegation: Licensee is not ensuring that resident's representative has prompt access to review resident's records. It is alleged that on 02/03/25 a request for R-1's records was sent to this facility and that R-1's records have not been provided. Per Administrator interview, R-1’s records were not provided to the requestor as per Title 22, Section 87468.2(a)(19). Allegation is corroborated.

**Refer to LIC 9099C for the continuation of this report**.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

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-20250227113642

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: YEARLING BOARD AND CARE	FACILITY NUMBER: 198603276
	VISIT DATE: 03/04/2025

NARRATIVE

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Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiency is being cited according to Title 22, Division 6 Health and Safety Code, Chapter 3.2 Residential Care Facilities for the Elderly. Refer to LIC 9099D.

An exit interview was held. A copy of this report along with appeal rights were provided to Isabel Tangonan.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250227113642

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: YEARLING BOARD AND CARE	FACILITY NUMBER: 198603276
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/04/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/11/2025 Section Cited CCR 87468.2(a)(19)	1 2 3 4 5 6 7	Personal Rights of Residents in Privately Operated Facilities (a) Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(19) To have prompt access to review all of their records and to purchase	1 2 3 4 5 6 7	Administrator to provide R-1's records to the authorized/designated representative and provide proof of delivery to LPA Irra by POC due date.
	8 9 10 11 12 13 14	photocopies of their records. Photocopied records shall be provided within two (2) business days & at a cost that does not exceed the community standard for photocopies. This standard is not met as evidence by: R-1 requested documents were not provided within (2) days of request.	8 9 10 11 12 13 14
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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.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

LIC9099 (FAS) - (06/04)

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