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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 07/02/2026
Date Signed: 07/02/2026 10:50:33 AM

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
05/26/2026 and conducted by Evaluator Bonnie Tao
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260526115258
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: 143DATE:
07/02/2026
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Kuliema Blueford, Business office managerTIME COMPLETED:
10:50 AM
ALLEGATION(S):
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Staff do not ensure facility vehicle is in good repair.
INVESTIGATION FINDINGS:
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***This report supersedes the report dated 05/28/26. The superseded report was created to revise the regulation cited on the deficiency page LIC9099 D. The finding of the allegation remains as substantiated. ***

Licensing Program Analyst (LPA) Tao conducted an unannounced subsequent visit on 07/02/2026 due to the revised citation. The initial visit was conducted by LPA Tao on 05/28/2026. Upon arriving at the facility, LPA met with Business Office Manger, Kuliema Blueford. LPA explained the purpose of today’s visit and discussed the allegation mentioned above to Administrator.

The investigation consisted of residents/staff interviews, physical plant tour and facility records review. LPA obtained residents/staff roster, and residents’ facility files.

(-continued on LIC 9099C-)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
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 3
Control Number 28-AS-20260526115258
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: 07/02/2026
NARRATIVE
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***This report supersedes the report dated 05/28/26. The superseded report was created to revise the regulation cited on the deficiency page LIC9099 D. The finding of the allegation remains as substantiated. ***

The investigation revealed that, in regard of facility staff do not ensure facility vehicle is in good repair, it is alleged that facility van sliding door is not working. Per resident interviews, one (1) out of twelve (12) residents interviewed was unable to comprehend the interview questions. Two (2) out of twelve (12) residents interviewed stated the facility van's sliding door was jammed. The rest of the nine (9) residents could not corroborate with the allegation. It was revealed that they were not aware of the facility van's sliding door is not working.

Per staff interviews, all five (5) out of five (5) staff interviewed could not corroborate with the allegation. Per observation during the physical plant tour with the Administrator, the facility van's door was jammed, the door handle was missing which required a tool to unlatch the door when opening it. Therefore, the facility vehicle is not in good repair.

Based on record review, observation and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code.

An exit interview was conducted with Kuliema Blueford, Business Office Manager. The findings were discussed. Copies of LIC 9099s report and appeal rights were provided.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260526115258
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: 07/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2026
Section Cited
CCR
87312
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...Any vehicle used by the facility to transport residents shall be maintained in a safe operating condition.

This requirement was not met as evidenced by:
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Administrator agreed to repair the facility van's sliding door and submit the proof of repair to licensing by the POC due date. POC was cleared on 06/10/26.
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The facility van's sliding door is jammed and not operable.

This poses a potential health and safety risk to residents in care.
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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: Lisa Hicks
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3