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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 12/09/2025
Date Signed: 12/09/2025 04:51:32 PM

Unsubstantiated


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
12/04/2025 and conducted by Evaluator Luis DeLeon
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251204134917
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: 148DATE:
12/09/2025
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Jaqueline CortezTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not dispense medications in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Luis De Leon conducted an initial unannounced complaint investigation visit for the allegation listed above. LPA met with the Administrator Jacqueline Cortez and explained the reason for the visit.

The investigation consisted of the following: On today’s visit, LPA De Leon toured the physical plant and obtained the current client and staff roster. LPA obtained relevant copies of resident file records such as admission agreement, physician's report, needs and service plan, physician's orders, and Medication Administration Record (MAR) logs.

Report continues on page LIC-9099C...
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
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-20251204134917
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: 12/09/2025
NARRATIVE
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Regarding allegation: Staff did not dispense medications in a timely manner.

It is alleged that staff did not give residents the morning medication in a timely manner even though that R1 was in the room. R1 confronted staff and staff denied seeing R1 in the room. The investigation reveals the following: interview with staff revealed that seven (7) out of seven (7) staff denied the allegation above. Staff described the process that staff follow to give out residents medication. Staff described that there is a set period on each morning, noon, evening, and bedtime where staff will go to residents’ rooms to give residents the medication. Med Tech will go to dining room to find residents to give them their medication. If not found, Med Tech staff will go to resident’s rooms. If resident is not found, Med Tech staff will inquire from caregiver if caregiver has seen residents. Staff indicated that staff makes an effort to locate residents in the facility and sometimes even outside the facility across the street in the park. If resident is still not found, the proper documentation is done and administrator is informed so that the follow up calls can be made. Interview with residents revealed that eight (8) out of ten (10) residents denied the above allegation. The residents indicated that staff always find them in the facility to get their medication. R10 indicated that in some instances staff has gone across the street, in the park, to give R1 medication. LPA reviewed five (5) out of five (5) resident MARs records with their respective medication and observed that all missing dosage was properly documented for medication refusal, out of facility for appointments or other activities. LPA did not observed any health and safety risk from medication dispensing. Based upon the investigation, resident and staff interviews, document review, and LPA observations, the facility is dispensing medication in at timely manner within each medication period throughout the day for residents in care.

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



Exit interview held with Jacqueline Cortez. A copy of the report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC9099 (FAS) - (06/04)
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