198603444-3-10-2026-28-AS-LHIS-DS9QTV-20260317122746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603444
Report Date: 03/10/2026
Date Signed: 03/10/2026 05:06:40 PM

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
03/06/2026 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260306101319

FACILITY NAME:	EVEREST AT WALNUT VALLEY SENIOR LIVING		FACILITY NUMBER:	198603444
ADMINISTRATOR:	DONGHYUN MOON		FACILITY TYPE:	740
ADDRESS:	19850 COLIMA ROAD		TELEPHONE:	(909) 595-5030
CITY:	WALNUT	STATE: CA	ZIP CODE:	91801
CAPACITY:	120	CENSUS: 85	DATE:	03/10/2026
		UNANNOUNCED	TIME BEGAN:	12:19 PM
MET WITH:	Donghyun Moon - Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Resident sustained bruises, due to staff neglect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced complaint visit regarding the above-mentioned allegation. LPA met with Donghyun Moon, Administrator and explained the reason for the visit.

The investigation consisted of the following: LPA conducted a tour of the facility, obtained copies of the Staff and Resident rosters, Staff in-service training log on Mandated reporting, Personal rights and Gait mobility/Repositioning of residents, Staff 72-hour log notes and Resident #1 (R1)'s files such as: Face sheet/Identification and Emergency Information, Physician's Report, Medication list, Hospice care plan and notes, Unusual Injury/Incident Report/SIR, photo of R1's arm, LPA also interviewed Staff #1 (S1) - Staff #5 (S5), Resident #1 (R1) - Resident #8 (R8) and Hospice Nurse #1 (N1).

The investigation revealed the following:
Regarding the allegation: "Resident sustained bruises, due to staff neglect." It is alleged that a large bruise was observed on R1's left arm while being given a shower. In addition, R1 has been observed to have bruises several times in the past. *****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026

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-20260306101319

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: EVEREST AT WALNUT VALLEY SENIOR LIVING	FACILITY NUMBER: 198603444
	VISIT DATE: 03/10/2026

NARRATIVE

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Interviews conducted with staff members indicated they have seen R1's bruise on the left arm but denied it was caused by neglect. Staff members interviewed indicated they have never physically abused or handled R1 or any of the residents in a rough manner, nor have they seen it happen. Staff members also stated that they have received the necessary training on how to transfer the residents and how to reposition them. S5 stated that R1 has had the bruise on her arm since December 2025 and has taken actions and interventions to prevent the bruising. S5 also indicated that aging causes R1 to have thinner or fragile skin and that the bruise on R1 may have been caused by medication side effects. Some staff stated that on either March 6 or March 7, 2026, the police came to conduct a welfare check on R1 but did not have any information nor contact details provided to them. Documents reviewed revealed that the facility has sufficient staffing and that the staff members have the proper documentation and notes. Moreover, the photos of R1's bruise appeared to be consistent with R1's thin skin and possible medication side effects. During the visit, LPA observed S3 and N1 assisting and transferring R1 from wheelchair to bed. Interviews conducted with (8) residents indicated they have not been hit or handled aggressively by any of the staff. All residents interviewed indicated that staff are well trained, helpful and nice to them. Interview with R1 revealed that the staff are nice to them and they had not been hurt nor injured by any staff. Additionally, R1 does not have a roommate and there were no witnesses, surveillance footage, or evidence obtained during the investigation to corroborate with the allegation.

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 allegation is UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided to Donghyun Moon, Administrator.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026

LIC9099 (FAS) - (06/04)

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