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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 02/19/2026
Date Signed: 02/19/2026 12:03:49 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
01/14/2026 and conducted by Evaluator Mayra Cota
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260114170504
FACILITY NAME:SANTA ANITA ASSISTED LIVINGFACILITY NUMBER:
198603535
ADMINISTRATOR:JACQUELINE CORTEZFACILITY TYPE:
740
ADDRESS:5600 GRACEWOOD AVENUETELEPHONE:
(626) 442-8410
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY:150CENSUS: 147DATE:
02/19/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jacqueline Cortez, Executive DirectorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Payment was not authorized by resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted a subsequent complaint visit today to deliver findings regarding the above-mentioned allegation. LPA, met with Jacqueline Cortez, Executive Director, and the reason for the visit was explained.

The investigation consisted of the following:

During initial visit conducted on 1/26/2026, LPA toured common areas of the facility, obtained copies of staff and resident rosters, interviewed Staff 1 – Staff 7 (S1-S7) and Resident 1 – Resident 9 (R1-R9). LPA, also reviewed and collected copies of R1’s Face Sheet, Residence and Care Agreement and Payer Adendum, Rent Payment receipts for April – December 2025, payment transaction history for September – December 2025 and Request for Refund report for January 9, 2026. Copies of facility’s Plan of Operation, Rent Payment Schedule, and Business Manager's itinerary for October 2025 were also obtained.
During today's visit, LPA obtained copies of staff and resident rosters and toured the common areas of the facility. LPA also interviewed Staff 8 (S8) during the span of the investigation. ***Continues on LIC 9099-C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
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 5
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
01/14/2026 and conducted by Evaluator Mayra Cota
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260114170504

FACILITY NAME:SANTA ANITA ASSISTED LIVINGFACILITY NUMBER:
198603535
ADMINISTRATOR:JACQUELINE CORTEZFACILITY TYPE:
740
ADDRESS:5600 GRACEWOOD AVENUETELEPHONE:
(626) 442-8410
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY:150CENSUS: 147DATE:
02/19/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jacqueline Cortez, Executive DirectorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Resident was not notified of payment made to the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted a subsequent complaint visit today to deliver findings regarding the above-mentioned allegation. LPA, met with Jacqueline Cortez, Executive Director, and the reason for the visit was explained.

The investigation consisted of the following:

During initial visit conducted on 1/26/2026, LPA toured common areas of the facility, obtained copies of staff and resident rosters, interviewed Staff 1 – Staff 7 (S1-S7) and Resident 1 – Resident 9 (R1-R9). LPA, also reviewed and collected copies of R1’s Face Sheet, Residence and Care Agreement and Payer Adendum, Rent Payment receipts for April – December 2025, payment transaction history for September – December 2025 and Request for Refund report for January 9, 2026. Copies of facility’s Plan of Operation, Rent Payment Schedule, and Business Manager's itinerary for October 2025 were also obtained.
During today's visit, LPA obtained copies of staff and resident rosters and toured the common areas of the facility. LPA also interviewed Staff 8 (S8) during the span of the investigation. ***Continues on LIC 9099-C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
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-20260114170504
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: 02/19/2026
NARRATIVE
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The investigation revealed the following:

Regarding: Resident was not notified of payment made to the facility.

It is alleged that the facility withdrew funds without notifying the resident.

S1 and S8 deny the allegation. Staff indicated that R1 was notified verbally that R1 had an unpaid rent balance for the month of September 2025. S8, who is in charge of handling resident rent payments, indicated that S8 provided R1 with a verbal reminder that R1 still had a balance for unpaid rent for September 2025. S8 indicated that R1 was notified that a withdrawal for partial payment in the amount of $420.07 was made on 10/8/2025 after R1 verbally provided consent for S8 to move forward with the withdrawal. S8 further indicated that the withdrawal took place during a meeting with R1 in S8’s office on 10/8/2025. Interview with R1 indicated that a meeting with S8 on 10/8/25 did not happen. R1further indicated that they did not receive verbal or written notice reminding them about unpaid rent from September 2025, nor notification about the facility making the withdrawal on 10/8/25. During the investigation, it has been determined that there is not enough information to corroborate the allegation that resident was not notified of payment made to the facility.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. 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: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20260114170504
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: 02/19/2026
NARRATIVE
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The investigation revealed the following:

Regarding: Payment was not authorized by resident.

It is alleged that staff withdrew an additional $400 in October 2025 without authorization from R1 even though rent is automatically withdrawn each month.

Interviews with S1 and S8 revealed that staff withdrew an additional $420.07 on 10/8/2025 for partial payment for September 2025 rent from R1’s account. Interview with S8, who is in charge of handling resident rent payments indicated that S8 provided R1 with a verbal reminder that R1 had a balance for the amount of $1,420.07 for September 2025 rent and therefore, R1 gave S8 verbal authorization to withdraw the money from R1’s account. S8 indicated that R1 authorized the withdrawal for the amount of $420.07 on 10/8/2025 as a partial payment for September 2025 rent and R1 agreed to pay the remaining $1,000.00 at a later time. S8 stated that S8 and R1 conducted a verbal payment plan so that R1 could pay off the remaining $1,000.00, but S8 did not document the terms of the payment plan at the time. S8 further indicated the authorization to withdraw the $420.07 from R1’s account was provided by R1 verbally, and nothing in writing was obtained from R1 to confirm the authorization from R1 to withdraw the additional $420.07 for September 2025 rent. Interview with R1 indicated that R1 did not authorize S8 to withdraw $420.07 on 10/8/2025 from R1’s account to pay off a portion of a balance for September 2025 rent. R1 indicated that R1 did not provide staff with verbal or written consent to withdraw the additional $420.07 on 10/8/2025. Interviews with R2-R9 indicated that they have no concerns with how the facility manages their rent payments. However, LPA review of payment history records indicated that on 10/6/2025, the facility processed a payment for October 2025 rent in the amount of $1,420.00 but also processed an additional payment in the amount of $420.07 on 10/8/2025. During record review, facility was unable to furnish email communications, correspondence or consent/authorization forms which would indicate that R1 authorized the additional withdrawal made on 10/8/2025 from R1’s account. Interviews and record review corroborate the allegation that staff withdrew an additional $420.07 from R1’s account without authorization.

The preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulation (Title 22), is being cited on the attached LIC 9099-D. An exit interview was conducted with Jacqueline Cortez, Executive Director and a copy of this report, 9099-D, and Appeal Rights was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20260114170504
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: 02/19/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2026
Section Cited
CCR
87507(g)(3)(G)
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Admission Agreements (g) Admission agreements shall specify the following:
(3) Payment provisions, including the following: (G) A comprehensive description of billing and payment procedures. This requirement is not met as evidenced by:
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The licensee shall ensure the admission agreement specifies rent payment provisions, including description of billing and payment procedures. Licensee will also ensure that procedures for notification to residents for payments made or balances due (continues below)
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Based on record review, Resident 1's admission agreement does not indicate rent payment provisions for payment procedures and proper notification to resident for outstanding balances if it applies, which poses a potential personal rights risk to residents in care.
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are also included in residents' admission agreement. The licensee shall review all the residents' admission agreements to ensure that regulation policies are included accurately. Licensee will submit a statement indicating the resident records have been reviewed and a statement acknowledging the regulation have been read by POC due date.
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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: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5