198603444-6-16-2026-28-AS-LHIS-DVLSY3-20260702141651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603444
Report Date: 06/16/2026
Date Signed: 06/16/2026 01:28:30 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
06/09/2026 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260609142602

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:	91789
CAPACITY:	120	CENSUS: 81	DATE:	06/16/2026
		UNANNOUNCED	TIME BEGAN:	09:37 AM
MET WITH:	Donghyun Moon - Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff does not ensure resident is allowed to be readmitted to the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced complaint investigation 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 obtained a copy of the staff & resident rosters, SNF Admission record, Walnut Police report (SEAR 06/09/2026), Resident #1 (R1) files such as Identification and Emergency Information (Face sheet), Admission agreement, Pre admission appraisal, Medical Assessment, Appraisals Needs and services plan, Medication administration record (MAR) for May 2026 and Physician's reassessment letter (06/09/2026). LPA interviewed Staff #1 (S1) - Staff #3 (S3) and Resident 2 (R2) – Resident #9 (R9). Resident #1 (R1) was not interviewed because they are in a Skilled Nursing Facility (SNF). *****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026

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-20260609142602

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: 06/16/2026

NARRATIVE

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The investigation revealed the following:

Allegation: Staff does not ensure resident is allowed to be readmitted to the facility. It is alleged that on 06/09/2026, facility is refusing to readmit R1 from SNF due to care needs unless they are placed on hospice care. All staff interviewed denied the allegation. Staff stated that R1 was transferred to SNF on 05/19/2026 due to worsening respiratory conditions. Prior to R1's release at SNF, S3 re-assessed R1 on 06/10/2026 to ensure that their needs are met upon their return. However, S3 determined that R1's condition has changed requiring a higher level of care that the facility was unable to provide. R1 also has a highly communicable condition that poses a high risk of infection to both staff and the current residents if readmitted. Staff informed R1's family about the decision and facility will provide a 30-day eviction notice to terminate the residency agreement. Staff also added that they are prepared to assist in finding appropriate alternative placement for R1. (5) of (8) residents stated that the facility readmitted them to the facility after being hospitalized, without any issues. All (8) residents stated that staff provide the care and assistance they need. LPA reviewed R1’s physician reassessment which confirmed that R1 requires a higher level of care due to their complex healthcare needs, chronic comorbidities and high risk of antibiotic resistance. In addition, physician stated that the facility is unable to provide services suitable for R1. Documentation reviewed and interviews conducted do not corroborate this allegation.

Based on statements and interviews conducted with residents and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the 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 conducted 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: 05/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026

LIC9099 (FAS) - (06/04)

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