198603535-10-30-2025-28-AS-WSHO-DP72GL-20251208162318

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 10/30/2025
Date Signed: 10/30/2025 02:51:21 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
10/27/2025 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251027134925

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: 149	DATE:	10/30/2025
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Jackie Cortez		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff does not maintain adequate food supply at facility.
Staff denied resident food.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted a visit to investigate the above allegations. LPA met with Vera Sebastian (Wellness Director). Jackie Cortez (Administrator) arrived at approximately 8:40 A.M.. LPA discussed the purpose of this visit.

During this visit, LPA obtained a copy of the resident and staff rosters, interviewed Staff #1 (S-1) through Staff #9 (S-9), interviewed Resident #1 (R-1) through Resident #15 (R-15), obtained a copy of the October 2025 food menu, a copy of the lunch and dinner list of food alternatives, a copy of the food chat meeting conducted on 10/21/25 (including sign-in sheet) and conducted a tour of the kitchen (including the food supply).

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20251027134925

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: 10/30/2025

NARRATIVE

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Allegation: Staff does not maintain adequate food supply at facility. It has been alleged that on 10/26/25, staff served a resident (resident arrived late to dinner) spaghetti without sauce and that the facility is running out of food. Staff interviews revealed that this facility maintains adequate food supply at all times. Interviewed staff indicated that this facility is not running out of food. (5) out of (9) interviewed staff indicated that this facility receives food supply (perishable and non-perishable) twice per week (Monday’s and Thursdays). (5) out of (9) interviewed staff indicated that on 10/26/25, the spaghetti served had meat sauce mixed in with the spaghetti noodles (sauce was not served on the side). Interviewed staff indicated that this facility also offers food alternatives to residents as well. Resident interviews revealed that this facility has adequate food supply. Interviewed residents indicated that the spaghetti served had the spaghetti sauce mixed in with the spaghetti noodles. Interviewed residents indicated that this facility also offers alternative food options. Interviewed residents did not have any concerns pertaining to this matter. LPA conducted a tour of the kitchen and observed ample food supply (perishable and non-perishable) to meet the meals noted on the menu. Interviews and tour do not corroborate this allegation.

Allegation: Staff denied resident food. It has been alleged that on 10/26/25, staff denied making more “meat sauce” for resident and that staff denied to provide dinner to the resident. Staff interviews indicated that staff do not deny food to clients (including meals). Interviewed staff indicated that the spaghetti had the meat sauce mixed in with the spaghetti noodles (sauce was not served on the side). Interviewed residents indicated that staff have not denied any food nor meals to residents. Interviewed residents indicated they do not have any concerns. Interviews do not corroborate this allegation.

Although the allegation(s) 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 allegations are UNSUBSTANTIATED.

Exit interview was conducted and a copy of this report and appeal rights were provided to Jackie Cortez.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025

LIC9099 (FAS) - (06/04)

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