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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603511
Report Date: 10/23/2025
Date Signed: 10/23/2025 12:56:21 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
10/17/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251017163919
FACILITY NAME:REM CALIFORNIA, LLC - PARK STREETFACILITY NUMBER:
198603511
ADMINISTRATOR:MURRAY, MARSHAFACILITY TYPE:
735
ADDRESS:9559 PARK STREETTELEPHONE:
(562) 263-6036
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:3CENSUS: 3DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Shonyae King - CaregiverTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Facility does not have a 2 day perishable/7 day non-perishable supply of foods.
Facility's client shower is not being maintained in a safe operating condition.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced visit to investigate the above allegations. LPA met with Caregiver Shonyae King and explained the purpose of the visit.

This facility is a vacant facility that is being used as a temporary relocation for clients that reside at a sister facility of the licensee as the clients primary facility is being fumigated.

The investigation consisted of the following:
LPA toured facility, inspected kitchen and bathrooms, reviewed Shift Change House Notes and conducted interviews with 2 clients and 3 staff.


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

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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
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
10/17/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251017163919

FACILITY NAME:REM CALIFORNIA, LLC - PARK STREETFACILITY NUMBER:
198603511
ADMINISTRATOR:MURRAY, MARSHAFACILITY TYPE:
735
ADDRESS:9559 PARK STREETTELEPHONE:
(562) 263-6036
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:3CENSUS: 3DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Shonyae King - CaregiverTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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9
Staff do not provide residents with toiletry item.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced visit to investigate the above allegations. LPA met with Caregiver Shonyae King and explained the purpose of the visit.

This facility is a vacant facility that is being used as a temporary relocation for clients that reside at a sister facility of the licensee as the clients primary facility is being fumigated.

The investigation consisted of the following:
LPA toured facility, inspected kitchen and bathrooms, reviewed Shift Change House Notes and conducted interviews with 2 clients and 3 staff.

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

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20251017163919
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 - PARK STREET
FACILITY NUMBER: 198603511
VISIT DATE: 10/23/2025
NARRATIVE
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The investigation revealed the following:
Allegation: Staff do not provide residents with toiletry item.
It is alleged that the facility does not have sufficient amount of toilet paper for the clients in care. LPA toured both restrooms and observed sufficient supply of toilet paper in cabinets/drawers. LPA interviewed 3 staff and each stated that there was a few days (3-4 days) where the facility was extremely low on toilet paper and staff had to self-purchase items for the clients. Per Shift Change House Notes there were notes and reminders from each shift expressing the concern of low/no toilet paper in the facility. Although staff and the notes corroborate the allegation, based on LPAs observations there is not sufficient evidence that there was no toilet paper in the facility.

Based on statements and interviews conducted with staff/clients, our of facility and LPA observation, there was not enough supportive evidence to concur with the reported 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 held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20251017163919
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 - PARK STREET
FACILITY NUMBER: 198603511
VISIT DATE: 10/23/2025
NARRATIVE
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The investigation revealed the following:
Allegation: Facility does not have a 2 day perishable/7 day non-perishable supply of foods.
It is alleged that since 10/11/25 there have been no groceries provided for the residents and there are very few perishable foods available. LPA toured kitchen and observed what appears to be sufficient 7 day non-perishable canned items, however, the required 2 day non-perishable items were extremely low with very little vegetables and poultry items. LPA interviewed 3 staff and each confirmed the above allegation and stated that management has been informed of the low food supply and have been doing their best to make meals with what they have. LPA spoke with Program Supervisor via phone call and she stated that the facility does not have a large quantity of food as this facility is being used temporarily as the primary facility is being fumigated, LPA asked if they have a planned return date and Program Supervisor stated that there is no definite return date yet but they are anticipating for 10/29/25. LPA reviewed Shift Change House Notes from 10/14/25 – 10/18/25 with each shift stating that the facility was low on food supply along with notes indicating that staff had to purchase supplies and water on their own throughout that time frame, it was observed per the notes that on 10/18/25 the facility was provided with the needed supplies.

Allegation: Facility shower is not being maintained in a safe operating condition.


It is alleged that the client shower that is used daily for showers does not have the required shower curtain needed to ensure privacy and to ensure water is not being splashed throughout bathroom nor the required non-slip mat . LPA toured client bathroom and observed client shower to not have proper shower curtain, the shower was turned on and demonstrated during visit and LPA observed water spaying around the floor and reaching outside of the shower area, also there was not a non-slip shower mat present in facility, which is a hazard for potential slips and falls. LPA interviewed 3 staff during visit and each confirmed the above allegation and stated that since they have been at the facility (which is a temporary location as sister facility is being fumigated) they have not had a shower curtain and water has been splashing in restroom causing it to be slippery and be a potential fall risk to the clients in care.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 and 6 are being cited on the attached LIC 9099D. 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: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20251017163919
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 - PARK STREET
FACILITY NUMBER: 198603511
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2025
Section Cited
CCR
85076(d)(1)
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85076 Food Service (d) The licensee shall meet the following food supply and storage requirements: (1) Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidence by:
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Administrator/Licensee to purchase the required amount of food and send a picture of the food supply and a copy of the Meal Plan/Schedule to LPA via email by POC due date. tena.herrera@dss.ca.gov
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LPA toured kitchen and observed 2 packs of chicken in freezer, one pack of frozen vegetables, 1 pack of refrigerated vegetables, 2 cobs of corn, 2 cucumbers, 2 pack of lettuce, 1 pack of mini carrots and 2 bell peppers based on this observation this is not enough for a 2 day supply of fresh perishable foods for 3 clients.
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Type B
10/24/2025
Section Cited
CCR
80088(e)(3)
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80088 Furniture, Fixtures, Equipment, and Supplies (e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (3) All toilets, hand washing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences shall be provided in facilities accommodating physically handicapped clients who need such items. This requirement was not met as evidence by:
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Administrator/Licensee to purchase the required non-slip shower mat and shower curtain, and put them in their designated areas, take photos and send photos to LPA via email by POC due date. tena.herrera@dss.ca.gov
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LPA toured client bathroom with walk in shower and there was no shower curtain nor anti slip mat in the shower or restroom, staff stated that the facility does not have one.
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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: 10/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5