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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603444
Report Date: 02/06/2025
Date Signed: 02/07/2025 08:20:51 AM

Unsubstantiated


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
01/31/2025 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250131144725
FACILITY NAME:EVEREST AT WALNUT VALLEY SENIOR LIVINGFACILITY NUMBER:
198603444
ADMINISTRATOR:MATSUMOTO,CHRISTINAFACILITY TYPE:
740
ADDRESS:19850 E COLIMA ROADTELEPHONE:
(909) 595-5030
CITY:WALNUTSTATE: CAZIP CODE:
91789
CAPACITY:120CENSUS: 88DATE:
02/06/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Christina Matsumoto, Executive DirectorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff are discriminating against resident.
Staff are not safeguarding residents belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegations listed above. LPA arrived unannounced and met with Executive Director, Christina Matsumoto.

LPA obtained copies of the staff and resident rosters, reviewed file for Resident #1, and interviewed the administrator, 4 Staff members, and 9 Residents.

For allegation – Staff are discriminating against resident. LPA interviewed staff and residents regarding this allegation. Staff stated they do not discriminate against residents. They provide reasonable accommodation if needed and treat residents fairly. For the incident in the dining room, the administrator stated she had explained and kindly asked the resident to move from the seat one time because it had been another resident’s daily seating. The resident got upset but got up to move on own.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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 2
Control Number 28-AS-20250131144725
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: EVEREST AT WALNUT VALLEY SENIOR LIVING
FACILITY NUMBER: 198603444
VISIT DATE: 02/06/2025
NARRATIVE
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Staff indicated that the resident occasionally comes out to the dining room to eat and had moved from table to table due to preference. They do not tell the resident that they cannot sit at a particular spot but would let the resident know of available spots. LPA interviewed 9 residents, and 8 out of the 9 feel that the staff are kind and respectful. They have not felt discriminated by staff or have seen them discriminate against others.

Allegation – Staff do not safeguard resident’s belongings. The administrator stated they try their best to safeguard belongings. The residents have their keys to their rooms and staff would only go in to do housekeeping or provide assistance. Staff interviewed do not touch or move residents' belongings without their consent. Staff stated that when a resident reports something missing/stolen, they would look for it right away. Sometimes the reported items were found misplaced in their rooms. LPA interviewed 9 residents. 3 out of the 9 residents have reported some of their belongings or money were stolen from their rooms. One of the residents stated their belongings were recovered after looking in the room. The rest of the residents did not have any missing or stolen items.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.



An exit interview was conducted. A copy of this report along with the appeal rights was provided to the administrator.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2