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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603505
Report Date: 12/06/2025
Date Signed: 12/06/2025 12:25:13 PM

Substantiated


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
12/02/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251202114433
FACILITY NAME:REM CALIFORNIA, LLC - GLENWOODFACILITY NUMBER:
198603505
ADMINISTRATOR:VANESSA VASQUEZFACILITY TYPE:
735
ADDRESS:2418 GLENWOOD PLACETELEPHONE:
(323) 249-8299
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:4CENSUS: 4DATE:
12/06/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jermaine Williams - CaregiverTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Staff did not provide medical attention in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to deliver findings on the above allegation. LPA met with Jermaine Williams and explained the purpose of today's visit.

The investigation consisted of the following:

During initial visit dated 12/4/25 LPA obtained copies of Client #1 (C1) discharge paper work from hospital, Interviewed 4 staff,1 Client and C1's parent/guardian.
On 12/5/25 LPA conducted 2 Staff interviews via telephone.
During todays visit 12/6/25 LPA typed report and delivered findings on the reported allegation.

(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2025
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 5
Control Number 28-AS-20251202114433
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: REM CALIFORNIA, LLC - GLENWOOD
FACILITY NUMBER: 198603505
VISIT DATE: 12/06/2025
NARRATIVE
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The Investigation Revealed the Following:

Allegation: Staff did not provide medical attention in a timely manner.


It is alleged that on 11/26/25 C1 was not taken to the hospital in a timely manner, while being in severe pain from a dental procedure that was done earlier in the day. LPA reviewed discharge paperwork from the emergency room dated 11/27/25 at 3:08am. Per interviews with 6 staff 5 out of the 6 staff observed C1 being uncomfortable profusely rubbing their face and spitting out an excessive amount of blood and saliva from 1pm till night shift arrived at 10pm. Per interview with S1 it was revealed that C1 had a dental appointment in the morning of 11/26/25 where C1s mom took them, C1 was in pain after the procedure and C1s mom took C1 to urgent care where medical treatment was not able to be done due to C1s behaviors/disability. S1 admitted to leaving a note for the night shift staff to take C1 to the hospital and stated they left the facility around 9pm that evening. Interviews with S3 and S5 stated at 2pm the note for the night shift staff was observed on the table. Interviews with S3-S6 revealed that the instructed note that said “NOC, Staff please take C1 to ER. One staff stay and one can take C1 in please”, and did not understand why upper management was waiting till the night staff arrived to take C1 to the ER knowing the visit was needed since approximately 2pm when the note was first observed. LPA spoke with C1 during the initial visit and they stated they are no longer in pain and showed LPA that teeth had been pulled out, C1 had redness around the mouth but did not appear to be in any pain or discomfort at the time of visit.


Based on LPAs observations and interviews which were conducted, and review of client files, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC9099-D. Exit interview held, and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 28-AS-20251202114433
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: REM CALIFORNIA, LLC - GLENWOOD
FACILITY NUMBER: 198603505
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
12/07/2025
Section Cited
CCR
80075(a)
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80075 Health Related Services
(a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services. This requirement was not met as evidence by:
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Licensee/Administrator to develop a written plan on how they will work with their staff to ensure clients are receving the necessary first aid and other medical/dental needs in a timely manner and send LPA a copy of that plan by POC due date. Additionally Licensee/Administrator is to conduct an all staff training on the regulation cited and share plan that was provided to LPA so that all personnel are on the same page. Proof of training materials and participant training log is to be emailed to LPA by 12/30/25.
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Per interviews with 6 staff it was confirmed that C1 demonstrated being in pain on 11/26/27 from 2pm until 10pm whent the night staff arrived. There was a note left on the table for night staff to take C1 to the Emergency that was noted to be observed since 2pm, C1 was not taken to the hospital until approximatly 11pm when 911 was called and paramedics took C1 to the hospital. Discharge paperwork from the hospital show C1 was discharged at 3:08am.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
12/02/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251202114433

FACILITY NAME:REM CALIFORNIA, LLC - GLENWOODFACILITY NUMBER:
198603505
ADMINISTRATOR:VANESSA VASQUEZFACILITY TYPE:
735
ADDRESS:2418 GLENWOOD PLACETELEPHONE:
(323) 249-8299
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:4CENSUS: 4DATE:
12/06/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Staff did not prevent resident in care from engaging in self-harm behaviors.
Facility does not maintain adequate sanitary supplies for cleaning.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with ___ and explained the purpose of today's visit.

The investigation consisted of the following:

During initial visit dated 12/4/25 LPA obtained copies of Client #1 (C1) discharge paper work from hospital, Interviewed 4 staff,1 Client and C1's parent/guardian.
On 12/5/25 LPA conducted 2 Staff interviews via telephone.
During todays visit 12/6/25 LPA typed report and delivered findings on the reported allegations.

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20251202114433
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: REM CALIFORNIA, LLC - GLENWOOD
FACILITY NUMBER: 198603505
VISIT DATE: 12/06/2025
NARRATIVE
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The Investigation Revealed the Following:

Allegation: Staff did not prevent resident in care from engaging in self-harm behaviors.


It is alleged that staff did not prevent C1 from injuring themselves by profusely rubbing face causing redness and irritation on face. Per interviews with 6 staff, each staff stated that C1 has existing behaviors of rubbing their mouth, however, due to the dental procedure that was done early morning of 11/26/25 C1 the behavior increased because of the discomfort C1 was in. Per S1-S3, C1 was monitored closely and had an aid by their side at all times, trying to comfort and clean C1. LPA did not obtain information that C1 was harming themselves and was the increased behavior was most likely due to the pain C1 was in from the tooth extractions they had in the morning.

Allegation: Facility does not maintain adequate sanitary supplies for cleaning.
It is alleged that facility is out of cleaning supplies. LPA toured facility and observed cleaning supplies in cabinet behind kitchen and back up cleaning supplies in the facility garage. Cleaning supplies included dish soap, clorox disinfectant wipes and disinfectant cleaning liquid. LPA interviewed 6 staff and 4 staff stated that although there may be supplies at the facility during the time of the incident there was low supply, LPA asked the staff if they were able to clean the areas and the client during the time and staff stated yes. During initial visit LPA advised S1 and S2 that it will be best practice to have written communication with management and staff when there are low supplies at the facility so a re-order is not forgotten.

Based on statements and interviews conducted with staff/clients, and review of client files, there was not enough supportive evidence to concur with the reported allegations. 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. Exit interview held, and a copy of this report was provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5