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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603504
Report Date: 07/03/2025
Date Signed: 07/03/2025 04:11:24 PM

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
05/30/2025 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250530124235
FACILITY NAME:LA POSADAFACILITY NUMBER:
198603504
ADMINISTRATOR:BEATRIZ ROMEO-LUIFACILITY TYPE:
740
ADDRESS:8120 PAINTER AVETELEPHONE:
(562) 945-2651
CITY:WHITTIERSTATE: CAZIP CODE:
90602
CAPACITY:114CENSUS: 73DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Beatriz Romeo-Lui, Executive Director and Brenna Randolph, Resident Care Coordinator TIME COMPLETED:
04:11 PM
ALLEGATION(S):
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Staff inappropriately removed resident from palliative care
Staff did not notify resident's POA of incident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez conducted a subsequent complaint investigation visit regarding the above allegations. LPA discussed the purpose of the visit with Wellness Director Anahi Reyes

06/06/2025 Licensing Program Analysts (LPAs) Lopez and Mallett conducted an initial 10-day complaint investigation visit regarding the above allegations. LPA discussed the purpose of the visit with Wellness Director Anahi Reyes.

The investigation consisted of: A physical plant tour of the interior common areas, obtaining and reviewing staff and resident rosters, and R1 progress notes. LPA asked for Palliative Care termination paperwork.


(continued on 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
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-20250530124235
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: LA POSADA
FACILITY NUMBER: 198603504
VISIT DATE: 07/03/2025
NARRATIVE
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(Continued from (9099)

07/03/2025 The investigation consisted of LPA taking a tour of facility, interviewing six (6) staff, eight (8) residents (#1 – #8), R9 Power of Attorney (POA). Obtaining and reviewing staff and residents rosters, R9 Physicians report dated 06/04/2024, emails from Executive Director and Resident Care Coordinator responding to POA regarding POA questions about services provided to R9, R9 Service plan, letter from Calstro Hospice dated 05/06/2025 addressed to La Posada regarding R9 discharge from services. Charting notes for R9 from 12/24/2024 to 06/04/2025

The investigation revealed, regarding allegation: Staff inappropriately removed resident from palliative care. It is alleged that the facility removed R9 from palliative care without notifying POA. Resident was admitted to the facility on 12/24/2024 and was on Bristol Hospice. On 02/06/2025, charting notes show that family asked for Hospice services to be terminated for R9. On 02/07/2025 R9 signed up for Calstro palliative care. On 02/19/2025 R9 was admitted to Med Choice Home Health. Charting notes show that on 05/09/2025, R9 received a final bath from Calstro palliative care on 05/09/2025. On a letter dated 05/06/2025 addressed to resident at facility address, it provided a termination of services date of 05/12/2025. One staff stated they were not aware that resident was terminated from Calstro palliative care and that when they inquired about this on 06/06/2025 after LPA asked for verification, Calstro palliative care sent copy of termination latter dated 05/06/2025. However, staff stated that the facility has no authority to terminate Calstro palliative care since that is between the resident’s doctor and resident or resident’s responsible party. There is insufficient evidence to substantiate this allegation.

Allegation: Staff did not notify resident's POA of incident. It is alleged that the facility did not notify residents Power of Attorney (POA) that resident had been terminated from Calstro palliative care.

LPA interviewed six (6) staff members and two (2) of six staff members stated that the facility was not aware that resident had been terminated from Calstro palliative care and that it is not the facilities responsibility to notify the POA or responsible party as Calstro palliative care deals directly with the family. Four (4) staff members stated they did not handle notifications to POA or responsible parties. LPA interviewed eight (8) residents and all eight (8) were not able to corroborate the allegation. There is insufficient evidence to substantiate this allegation.


Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted and a copy of this report was discussed and provided to Brenna Randolph, Resident Care Coordinator
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
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