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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 10/21/2025
Date Signed: 10/21/2025 05:01:31 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
10/14/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251014144300
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: 149DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Administrator Jacqueline CortezTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff are not safeguarding resident's personal property.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 10/22/2025 regarding the above allegations. LPA Ramirez identified herself to front desk staff and was greeted by Activities Director- Brenda Martinez. LPA Ramirez explained the purpose of today’s visit to Martinez.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Staff#1 - 7 interviews (S1 – S7), Resident#1 – 8 (R1 – R8), Copy of Admission Agreement, Review of Client/Resident Personal Property and Valuables (LIC 621) for R1 – R6, and physical plant tour.


SEE 9099-C for continued report
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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 6
Control Number 28-AS-20251014144300
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: 10/21/2025
NARRATIVE
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The investigation revealed the following: regarding the allegation “Staff are not safeguarding resident's personal property.” It is alleged staff are not safeguarding residents’ personal belongings such as clothing and delivery packages. Six (6) out of the ten (10) residents interviewed corroborated this allegation. R3 revealed that in July of 2025, R3 purchased items from Amazon and received confirmation from Amazon that the package was delivered to the facility’s front desk. According to R3, Amazon provided a photo as proof of package delivery, however, when R3 went to retrieve their package from the front desk, they were advised that their package was not there. R3 revealed after a week of searching for their package, R3 was notified by facility staff that their package was not located. R3’s family emailed S7 proof of delivery confirmation and proof of the items purchased. Interview with S2 and S7 corroborated R3’s statements. S2 revealed that because R3’s did not receive their package due to loss or theft after it was delivered to facility staff, R3 was reimbursed for the loss of their package. S2 revealed all resident packages are delivered to the front desk and front desk staff will safeguard these packages until the packages are picked up by residents. Interview with R2 revealed several articles of clothing were reported missing after staff picked up R2’s dirty laundry for washing. According to R2, some of their clothing was found and some were not located. Per Health and Safety Code 1569.153(c)(d)-"Documentation of lost and stolen resident property with a value of twenty-five dollars ($25) or more within 72 hours of the discovery of the loss or theft and, upon request, the documented theft and loss record for the past 12 months shall be made available to the State Department of Social Services, law enforcement agencies and to the office of the State Long-Term Care Ombudsman in response to a specific complaint. (d) A written resident personal property inventory is established upon admission and retained during the resident’s stay in the residential care facility for the elderly. Inventories shall be written in ink, witnessed by the facility and the resident or resident’s representative, and dated. A copy of the written inventory shall be provided to the resident or the person acting on the resident’s behalf. All additions to an inventory shall be made in ink, and shall be witnessed by the facility and the resident or resident’s representative, and dated. Subsequent items brought into or removed from the facility shall be added to or deleted from the personal property inventory by the facility at the written request of the resident, the resident’s family, a responsible party, or a person acting on behalf of a resident. The facility shall not be liable for items which have not been requested to be included in the inventory or for items which have been deleted from the inventory. A copy of a current inventory shall be made available upon request to the resident, responsible party, or other authorized representative. The resident, resident’s family, or a responsible party may list those items which are not subject to addition or deletion from the inventory, such as personal clothing or laundry, which are subject to frequent removal from the facility. SEE 9099-C for continued report
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20251014144300
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: 10/21/2025
NARRATIVE
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LPA Ramirez requested the facility theft and loss log for the last 12 months. Per S2, the facility does not maintain a theft and loss log. LPA Ramirez reviewed Client/Resident Personal Property and Valuables (LIC 621) for R1 through R6 and found these forms did not contain any entries of personal property and valuables. LPA Ramirez observed various personal belogings such as clothing, tv's, microwaves, lamps, radios and other valuables in ten (10) out of the ten (10) resident rooms toured. Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

One (1) Type A deficiency has been issued. Exit interview was conducted. A copy of this report, 9099-D and appeals rights was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 28-AS-20251014144300
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: 10/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
10/22/2025
Section Cited
CCR
87468.2(a)(25)
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(a) In addition to the rights listed in Section 87468.1, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (25) To protection of their property from theft or loss according to Health and Safety Code sections 1569.152, 1569.153, and
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Administrator will submit plan as to when all staff retraining will be conducted. Plan must be received by 10/22/25 via email. All staff will receive retraining on Health and Safety Code sections 1569.152, 1569.153, and 1569.154. Proof of staff retraining is required by 11/4/2025.
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1569.154. This requirement was not met as evidenced by: 6 out of 10 residents did not have property protected from theft or loss. This poses an immediate risk to the health, safety, or personal rights of persons 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: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
10/14/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251014144300

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: 149DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Administrator Jacqueline CortezTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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9
Staff are threatening a resident with an unlawful eviction.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 10/22/2025 regarding the above allegations. LPA Ramirez identified herself to front desk staff and was greeted by Activities Director- Brenda Martinez. LPA Ramirez explained the purpose of today’s visit to Martinez.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Staff#1 - 7 interviews (S1 – S7), Resident#1 – 8 (R1 – R8), Copy of Admission Agreement, Review of Client/Resident Personal Property and Valuables (LIC 621) for R1 – R6, Review of R3,s resident file, and physical plant tour.


SEE 9099-C for continued report
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20251014144300
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: 10/21/2025
NARRATIVE
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The investigation revealed the following: regarding the allegation “Staff are threatening a resident with an unlawful eviction.” It is alleged that R3 is being unlawfully evicted. One (1) out of ten (10) residents interviewed corroborated this allegation. Interviews with seven (7) out of seven (7) staff interviewed denied this allegation. Review of R3’s resident record did not corroborate this allegation. Interview with R3 revealed they have never been served with an eviction notice nor have they been threatened with an eviction. 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.

No deficiencies were cited for this complaint allegation. A copy of this report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6