198603476-7-10-2026-28-AS-DSIS-DX6NWA-20260821104912

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603476
Report Date: 07/10/2026
Date Signed: 07/10/2026 11:14:10 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
07/07/2026 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260707113650

FACILITY NAME:	LA MIRADA VILLA FOR THE ELDERLY		FACILITY NUMBER:	198603476
ADMINISTRATOR:	DE HONOR, ELIZA		FACILITY TYPE:	740
ADDRESS:	15005 LA FONDA DR.		TELEPHONE:	(714) 342-8236
CITY:	LA MIRADA	STATE: CA	ZIP CODE:	90638
CAPACITY:	6	CENSUS: 5	DATE:	07/10/2026
		UNANNOUNCED	TIME BEGAN:	08:56 AM
MET WITH:	William Del Rio, Caregiver		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Staff did not provide adequate communication with authorized representative.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced 10-day complaint visit at the facility and met with caregiver, William Del Rio and LPA explained the purpose of the visit. LPA Konishi called the Administrator over the phone and LPA explained the purpose of the visit. The purpose of the visit is to investigate the above allegation.

The investigation consisted of the following: LPA interviewed the Staff #1 (S1) to Staff #3 (S3), Resident #1 (R1) to Resident #5 (R5) at the home. LPA also interviewed the Administrator, Witness #1 (W1) to Witness #5 (W5) over the phone. LPA obtained copies from Resident #1 (R1’s) file such as the Appraisal Needs and Services Plan, Physician’s Report, and other pertinent documents. LPA obtained copies of the resident roster and staff roster.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
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)

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Control Number 28-AS-20260707113650

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: LA MIRADA VILLA FOR THE ELDERLY	FACILITY NUMBER: 198603476
	VISIT DATE: 07/10/2026

NARRATIVE

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The investigation revealed the following: in regard to the allegation, “Staff did not provide adequate communication with authorized representative.” It is alleged that on 07/07/2026, R1’s authorized representative called the facility to confirm whether R1 was receiving the prescribed medications and to request medication orders for the authorized representative’s records. It is also alleged that the staff told the authorized representative to contact the Administrator and the disconnected the call and the facility has failed to call the authorized representative back. LPA interviewed the Administrator, three (3) out of three (3) staff that denied the allegation stating that they provide to R1’s authorized representative the prescribed medications information that R1 is receiving over the phone and stated not disconnecting the call. The Administrator also stated calling the authorized representative back on 7/9/2026 and left a voice message. LPA interviewed five (5) out of five (5) residents stating that the facility staff provides adequate communication with their authorized representative and stated having no issues being able to communicate with their authorized representative or loved one. LPA interviewed one (1) out of five (5) witnesses that corroborated with the allegation stating that the facility staff are not willing to provide information to the authorized representative and that the staff hung up on the witness once on 7/7/2026. LPA interviewed four (4) out of five (5) witnesses that denied the allegation stating that the staff provides adequate communication and that the staff are able to provide information when they ever request it and the staff also have not disconnected the call ever over the phone. There is not enough evidence to substantiate.

Based on statements and interviews conducted with staff, resident, and review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was held and a copy of this report was provided to the Caregiver, Nonila Ceralde.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
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)

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