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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603398
Report Date: 07/10/2026
Date Signed: 07/10/2026 10:42:25 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
06/09/2026 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260609102706
FACILITY NAME:GM HOME IIFACILITY NUMBER:
198603398
ADMINISTRATOR:MARTINEZ, SHERRYFACILITY TYPE:
735
ADDRESS:14771 RAGAN DRIVETELEPHONE:
(562) 946-9266
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:4CENSUS: 4DATE:
07/10/2026
UNANNOUNCEDTIME BEGAN:
08:44 AM
MET WITH:Susan MartinezTIME COMPLETED:
10:56 AM
ALLEGATION(S):
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Staff do not have the required training for residents restricted health care plans
Staff did not ensure that current, individualized restricted health care
plans for residents were completed properly
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced subsequent complaint visit in response to the above allegations. LPA met with DSP Maria Cristina Ching and explained reason for visit. Administrator Susan Martinez arrived shortly after.

The investigation consisted of the following: During the initial visit conducted on 06/11/2026 LPA Castro obtained copies of the client roster and staff roster. LPA reviewed the Corrective Action Plan (CAP) addressing the above allegations issued by Eastern Los Angeles Regional Center dated 06/01/2026 with Susan Martinez. Per Administrator Susan Martinez, she agrees with the CAP findings and will be complying with the CAP. LPA obtained copies of restricted heal care plans for C1 and C2 along with signed staff training for restricted health care plan, interviewed Administrator, staff #1-staff #3 (S1-S3), and delivered findings.

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

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
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 3
Control Number 28-AS-20260609102706
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: GM HOME II
FACILITY NUMBER: 198603398
VISIT DATE: 07/10/2026
NARRATIVE
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Allegation: Staff do not have the required training for residents’ restricted health care plans: It is alleged that staff did not have required training for restricted health care plans for C1 and C2. During interview with Administrator and staff all four (4) stated that staff did have training. Administrator stated that at time of regional center visit facility could not produce training due to training sheets being at another one of the homes. Administrator stated that moving forward all homes will have their own individual training logs. Per Administrator, she agrees with the CAP findings and has already complied with the CAP. Per CAP report and Administrator Susan Martinez agreement, this corroborates this allegation.

Allegation: Staff did not ensure that current, individualized restricted health care plans for residents were completed properly: It is alleged that C1 and C2’s restricted health care plan (RHCP) had not been reviewed and signed by primary care physician. During interview with Administrator, it was revealed that the old RHCP was signed and dated not the new one. Administrator stated that moving forward yearly RHCP will be signed and dated. Per Administrator, she agrees with the CAP findings and has already complied with the CAP. Per CAP report and Administrator Susan Martinez agreement, this corroborates this allegation.

Based on interviews conducted and document review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Deficiency is being cited according to California Code of Regulations, Title 22. Refer to LIC 9099D.

Exit interview conducted, appeal rights and this report was provided to Susan Martinez.

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

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260609102706
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: GM HOME II
FACILITY NUMBER: 198603398
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/13/2026
Section Cited
CCR
80092.1(g)
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80092.1 General Requirements for Restricted Health Conditions
(g) All new facility staff who will participate in meeting the client’s specialized care needs shall complete the training prior to providing services to the client.

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Administrator shall ensure training logs are kept at facility for all staff and that all new staff are trained for clients RHCP.
Administrator has already complied with all CAP requirements.
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Based on record review, on 05/27/26 regional center could not verify staff training for C1 and C2 RHCP's which poses a potential health and safety risk to persons in care.
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Type B
07/13/2026
Section Cited
CCR
80092.2(a)(1)
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80092.2 Restricted Health Condition Care Pla (a) If the licensee of an ARF chooses to care for a client with a restricted health condition, as specified in Section 80092, the licensee shall develop and maintain, as part of the Needs and Services Plan, a written Restricted Health Condition Care Plan. The plan must include all of the following:(1)Documentation that the client and the client's authorized representative, if any, the client's physician or a licensed professional designated by the physician, and the placement agency, if any, participated in the development of the plan.

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Administrator shall ensure RHCP's are signed and dated by physician moving fowrd.Administrator has already complied with all CAP requirements.
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Based on record review, on 05/27/26 regional center could not verify signautres from primary care physician for C1 and C2 RHCP's which poses a potential health and safety risk to persons in care.
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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: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3