198603535-1-30-2026-28-AS-WSHO-DRNP6K-20260226100228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 01/30/2026
Date Signed: 01/30/2026 04:34:06 PM

Substantiated

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
01/22/2026 and conducted by Evaluator Mayra Cota

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260122151256

FACILITY NAME:	SANTA ANITA ASSISTED LIVING		FACILITY NUMBER:	198603535
ADMINISTRATOR:	JACQUELINE CORTEZ		FACILITY TYPE:	740
ADDRESS:	5600 GRACEWOOD AVENUE		TELEPHONE:	(626) 442-8410
CITY:	TEMPLE CITY	STATE: CA	ZIP CODE:	91780
CAPACITY:	150	CENSUS: 147	DATE:	01/30/2026
		UNANNOUNCED	TIME BEGAN:	12:41 PM
MET WITH:	Jacqueline Cortez, Executive Director		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff are not ensuring that facility is clean and sanitary after meal services.
Staff do not follow resident’s care plan.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Mayra Cota, conducted a subsequent complaint visit to continue with the investigation regarding the above-mentioned allegations. LPA met with Jacqueline Cortez, Executive Director, and the reason for the visit was explained.

The investigation consisted of the following:

During initial 10-day complaint visit, LPA obtained copies of staff and resident rosters, conducted tour of the facility with a focus on inspecting the resident dining rooms and conducted interviews with Staff 1 – Staff 4 (S1-S4) and (7) residents. LPA also obtained copies of Care Plan for R1 and Plan of Operation.

During today’s visit, LPA obtained copies of staff and resident rosters, inspected the two facility dining rooms for residents, conducted interviews with Staff 5 – Staff 11 (S5-S11) and Resident 8 – Resident 12 (R8-R12). LPA also reviewed and obtained copies of Mealtime Schedules, Server Duty Logs for the month of January 2025.
****Continues on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

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 4

Control Number 28-AS-20260122151256

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: SANTA ANITA ASSISTED LIVING	FACILITY NUMBER: 198603535
	VISIT DATE: 01/30/2026

NARRATIVE

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The investigation revealed the following:

Regarding: Staff are not ensuring that facility is clean and sanitary after meal services.

Regarding: Staff are not ensuring that facility is clean and sanitary after meal services.

It is alleged that staff are leaving food out on the tables when returning for lunch and dinner, not cleaning tables and chairs, sweeping floors and leaving food on walls when residents spill something.

Interviews with (6) out of (11) staff who work directly in the kitchen and dining rooms indicated that the two resident dining rooms are cleaned before and after every meal service. Staff indicated that tables and chairs are cleaned and sanitized, floors are swept and mopped 2-3 times a day and spills are wiped down immediately. However, staff indicated that sometimes time is limited during cleaning and staff are unable to do more frequent cleaning of the walls and baseboards which have stains from drinks and food. Interview with S1 and S7 further indicated that walls, baseboards and some areas of the floors are hard to clean due dated surfaces. Interviews with (11) out of (12) residents indicated that they have no concerns regarding the dining rooms not being kept clean by staff. However, LPA inspection and observation of the two dining rooms during and after meal services revealed that several walls and baseboards have splattered stains from drinks and other food particles. LPA also observed dirt and grime stains around the corners of the floor by the grand piano and doorways in both dining rooms. Interviews with staff and LPA observation corroborate the allegation that staff are not ensuring that the facility is clean and sanitary after meal services.

Regarding: Staff do not follow resident’s care plan.

It is alleged that staff are not checking on resident every two hours as stated on their care plan.

Interviews with (6) out of (11) staff revealed that residents who are “independent” and do not require incontinence care are checked on “frequently” during a work shift which is 7.5 hours a day. Staff indicated that residents get visits from staff three times per shift if they are considered independent and do not require incontinence care which would be noted on their Care Plan. Interview with S1-S3 indicated that R1 is now receiving “frequent” checks due to being “independent” and not needing incontinence care. Staff further indicated that “frequent” checks for R1 are a minimum of 2 checks, maximum 3 checks per shift. However, review of R1’s Care Plan in R1’s resident file indicated that R1 has “safety checks – 4 times per shift.” Further interviews with S1 and S2 indicated that no changes to R1’s current Care Plan have taken place and therefore, the Care Plan stands. *****Continues on LIC 9099-C page 2*****

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20260122151256

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: SANTA ANITA ASSISTED LIVING	FACILITY NUMBER: 198603535
	VISIT DATE: 01/30/2026

NARRATIVE

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Interviews with (11) out of (12) residents indicated that their needs are being met by facility staff; however, staff interviews and record review corroborate the allegation that staff do not follow resident’s care plan.

Based on LPA’s observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations (Title 22), are being cited on the attached LIC 9099 D. An exit interview was conducted with Jacqueline Cortez, Executive Director and a copy of this report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20260122151256

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: SANTA ANITA ASSISTED LIVING	FACILITY NUMBER: 198603535
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/30/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/20/2026 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	Licensee will be paiting walls and baseboards and will do a deep clean on the floors to remove the grime througt the floors of both dining rooms. Licensee will send photos of the corrections by POC due date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: inspection and observation of the two dining rooms during and after meal services revealed that several walls and baseboards have splattered stains from drinks and other food particles. Also observed dirt and grime stains around the corners of the floor by the grand piano and doorways in both dining rooms.	8 9 10 11 12 13 14
Type B 02/06/2026 Section Cited CCR 87208(a)	1 2 3 4 5 6 7	87208(a) Plan of Operation (a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so...	1 2 3 4 5 6 7	Licensee will conduct an in-service training regarding following resident care plans to meet their needs and provide LPA proof of training via sign-in log and training topics and agenda.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: R1's Care Plan indicates safety checks to be conducted 4 times per shift; however, staff indicated that staff conduct safety checks 2 to 3 times per 7.5 hour shift	8 9 10 11 12 13 14

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: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

LIC9099 (FAS) - (06/04)

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