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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603383
Report Date: 07/31/2026
Date Signed: 07/31/2026 09:37:11 AM

Unsubstantiated


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
06/29/2026 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260629210807
FACILITY NAME:TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THEFACILITY NUMBER:
198603383
ADMINISTRATOR:KUMAR, SUBASHSANIFACILITY TYPE:
740
ADDRESS:1155 VIA VERDETELEPHONE:
(909) 293-6466
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:60CENSUS: 54DATE:
07/31/2026
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Courtney Cortez, Office ManagerTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Staff did not provide adequate supervision resulting in resident falling and sustaining injuries.
Staff over medicated resident.
Staff left resident soiled for an extended period of time.
Staff does not ensure facility is clean and sanitized.
Staff does not ensure resident's laundry needs are being met.
Staff placed a surveillance camera in resident's room without proper authorization.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Konishi conducted an subsequent unannounced complaint visit at the facility and met with the Office Manager, Courtney Cortez and LPA explained the purpose of the visit. LPA met with the Executive Director, Subishsani Kumar shortly after and LPA explained the purpose of the visit. The purpose of the visit is to investigate the above allegation(s).

On 7/23/2026, the initial investigation visit was conducted. The investigation consisted of the following:

The investigation consisted of the following: LPA interviewed the Executive Director, Staff #1 (S1) to Staff #6 (S6), and Resident #2 (R2) to Resident #7 (R7). LPA attempted to interview Resident #1 (R1) but LPA was unable to interview R1 since R1 did not answer any questions. LPA obtained copies from R1’s file, including Face Sheet, the Physician's Report, Identification and Emergency Information LIC 601 form, Medication Administration Record (MAR), Special Incident Reports, and other pertinent documents. LPA also obtained the staff and residents rosters.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2026
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 5
Control Number 28-AS-20260629210807
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: TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THE
FACILITY NUMBER: 198603383
VISIT DATE: 07/31/2026
NARRATIVE
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On 7/30/2026, LPA requested documentation from the Executive Director. The Executive Director sent documentation to the LPA by email on 7/30/2026.

During today's visit the investigation revealed the following: in regard to the allegation, “Staff did not provide adequate supervision resulting in resident falling and sustaining injuries.” It is alleged that on 06/22/2026, R1 sustained a bruised cheek, a bump behind R1’s ear, and in extreme pain from a fall due to inadequate staff supervision. LPA attempted to interview R1. However, R1 was unable to answer any questions. LPA interviewed the Executive Director, two (2) out of six (6) staff interviewed denied the allegation stating that R1 did experience a fall on 06/22/2026 and paramedics arrived to assess R1 which did not observe any injuries. Four (4) out of six (6) staff stated not witnessing R1 fall on 06/22/2026 but stated that whenever a resident has a fall, the facility protocol would be to contact the Med Tech to assess the resident and contact 9-1-1 for further assessment if it’s an unwitnessed or there’s a potential head injury. LPA reviewed a Special Incident Report (SIR) dated 6/24/2026 that indicated on 6/22/2026, R1 was observed on the floor at around 6:45am. Staff called 9-1-1 and Emergency Medical Services (EMS) determined that R1 did not need to be taken to the hospital. On the same date at around 10:45am, R1’s responsible party visited and requested R1 to be taken to the hospital via non-emergency ambulance for evaluation. Per Executive Director and one (1) out of six (6) staff stated that R1 was last room checked 4am, and 5:30am and staff observed R1 was in bed. One (1) out six (6) staff also stated that R1 was in bed at 6:30am during the medication pass time prior to finding R1 on the floor at around 6:45am. LPA interviewed five (5) out of six (6) residents that stated not experiencing fall and not witnessing any residents fall. One (1) out of six (6) residents stated not experiencing a fall but witnessed a resident fall and that staff immediately responded to check on the resident and contacted the ambulance. Six (6) out of six (6) residents all stated that the staff would immediately respond and help assess whenever a resident has a fall. There is not enough sufficient evidence to substantiate the allegation.



Allegation: “Staff over medicated resident.” It is alleged that through extensive testing at the hospital revealed that R1 had been over-medicated with Haldol at the facility. LPA interviewed the ED and two (2) out of six (6) staff interviewed denied the allegation stating that the facility has been following R1’s physician’s orders and Medication Administration Record (MAR). Based on record review, LPA observed that R1’s MAR indicated Haldol treating agitation to be given as needed and cannot exceed more than four (4) doses per 24 hours. [Continue to LIC9099-C]
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20260629210807
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: TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THE
FACILITY NUMBER: 198603383
VISIT DATE: 07/31/2026
NARRATIVE
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Haldol was provided to R1 by the facility from 06/13/2026 to 06/22/2026 which did not exceed more than 2 (two) doses per 24 hours. LPA interviewed Six (6) out of six (6) residents that denied the allegation stating that the staff have not over-medicated residents at the facility. Additionally, LPA was not provided with any evidence that indicated that the resident was in fact overmedicated with Haldol. There is not enough sufficient evidence to substantiate the allegation.

Allegation: “Staff left resident soiled for an extended period of time.” It is alleged that on 06/22/2026, R1 had a fall and appeared to have been on the floor for many hours, as R1 was lying in hardened feces that was difficult to remove and was covered on R1’s arms, legs, and hands. LPA interviewed the Executive Director, two (2) out of six (6) staff that denied the allegation stating that on 06/22/2026, the staff did not observe any hardened feces on R1’s arms, legs, and hands for an extended period of time. Four (4) out of six (6) staff stated not witnessing the incident that involved R1 on 06/22/2026 being left soiled for an extended period of time. However, that four (4) out of six (6) staff stated that the staff assist residents to the restrooms every two (2) hours or checked and/or incontinence supplies are changed every two (2) hours. Based on record review, LPA reviewed the SIR dated 6/24/2026 that on 6/22/2026, R1 was observed on the floor at around 6:45am. Staff called 9-1-1 and Emergency Medical Services (EMS) determined that R1 did not need to be taken to the hospital. No detail of injury or R1 being soiled was noted on the SIR. LPA interviewed six (6) out of six (6) residents that stated they do not receive incontinence services but observed no other resident stay wet, unkept, or not changed for a prolonged period of time. LPA also toured the facility, observed six (6) randomly selected resident’s bedrooms and six (6) bathrooms which were clean and free from smell of urine. LPA also observed the common areas, the lobby, activity room, dining room, and courtyard where there were many residents present and LPA did not detect any smell of urine. There is not enough sufficient evidence to substantiate the allegation.

Allegation: “Staff does not ensure facility is clean and sanitized.” It is alleged that facility and resident rooms were dirty. LPA interviewed the Executive Director, six (6) out of six (6) staff that denied the allegation stating that the caregivers conducts daily light cleaning in the rooms, trash our taken out daily, and housekeeping conducts deep cleaning of bedrooms are provided on a weekly basis, and the facility is cleaned by the housekeeping and maintenance staff on a daily basis. LPA interviewed six (6) out of six (6) residents that denied the allegation stated that their rooms and the facility are kept cleaned by staff.
[Continue to LIC9099-C]
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20260629210807
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: TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THE
FACILITY NUMBER: 198603383
VISIT DATE: 07/31/2026
NARRATIVE
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LPA also toured the facility, common areas, the lobby, the dining room, the activity room, and observed six (6) randomly selected bedrooms including R1’s bedroom and six (6) bathrooms which were all clean, not dirty, and had no bad odors. There is not enough sufficient evidence to substantiate the allegation.

Allegation: “Staff does not ensure resident's laundry needs are being met.” It is alleged that laundry was not completed weekly. LPA interviewed the Executive Director, six (6) out of six (6) staff that denied the allegation stating that laundry service is provided for residents on a daily basis or as needed. The Executive Director and six (6) out of six (6) staff also stated that especially when a resident has an accident or when linens and clothes are soiled, the facility would immediately conduct laundry service. LPA observed six (6) residents bedrooms hampers were empty. LPA also observed that six (6) residents bedrooms’ beds and linens were in good, clean condition. LPA interviewed five (5) out of six (6) residents that denied the allegation stating that the staff provide laundry service for the residents. One (1) out of six (6) residents corroborated with the allegation stating that there were times when laundry services were not provided and clothes were missing. LPA obtained R1 and residents’ weekly laundry schedule and R1 receives Laundry service every Wednesday. LPA also observed the facility’s laundry room which had multiple washing and drying machines operating properly. There is not enough sufficient evidence to substantiate the allegation.
Allegation: ”Staff placed a surveillance camera in resident's room without proper authorization.” It is alleged that cameras and motion detectors had been installed in residents’ rooms without notification. It is also alleged that the staff were unable to explain who monitored these devices or provided any related procedures. LPA interviewed the Executive Director and three (3) out of six (6) staff denied the allegation stating that the purpose of the motion detection cameras and that this device is currently not in use were informed to residents’ responsible parties. LPA observed fall detection cameras in R1’s and ten (10) residents’ bedrooms. LPA interviewed six (6) out of six (6) residents stating not able to recall if they were notified from the staff about the installation and purpose of the fall detection Sage Detect program cameras. Per discussion with the Executive Director, the fall detection Sage Detect program cameras are not in use as it’s currently pending department approval. Per Executive Director, the facility sent by email a notification to all residents’ responsible parties introducing the fall detection Sage Detect camera and the purpose of it on 2/18/2026. Per Executive Director, the facility sent by email a follow-up notification to all responsible parties on 3/9/2026 regarding the purpose of the fall detection Sage Detect program. There is not enough sufficient evidence to substantiate the allegation.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20260629210807
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: TERRACES AT VIA VERDE-A MEMORY CARE COMMUNITY, THE
FACILITY NUMBER: 198603383
VISIT DATE: 07/31/2026
NARRATIVE
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Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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 allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided to the Office Manager, Courtney Cortez.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5