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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 11/13/2025
Date Signed: 11/13/2025 02:53:31 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
11/04/2025 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251104130842
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: 145DATE:
11/13/2025
UNANNOUNCEDTIME BEGAN:
12:23 PM
MET WITH:Jacqueline Briceno, Executive DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff spoke to resident in an inappropriate manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Konishi conducted a subsequent unannounced complaint visit in regard to the allegation listed above. LPA met the Executive Director, Jacqueline Briceno, who assisted with today’s visit.

On 11/06/2025, the initial investigation visit was conducted. The investigation consisted of the following:
LPA interviewed Executive Director, Staff #1(S1) to Staff #5 (S5), and Resident#1 (R1) to Resident #14 (R14). LPA obtained copies of the following documents: staff roster, resident roster, R1’s face sheet and physician’s reports. LPA obtained copies of S1’s file such as Personnel Record LIC501 and Staff Training documents.

During today's visit, LPA obtained the following documents: staff and resident rosters. LPA interviewed the Executive Director, Resident #15 (R15) and Resident #16 (R16). LPA obtained Staff In-Service document.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
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-20251104130842
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: 11/13/2025
NARRATIVE
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The investigation revealed the following: in regard to the allegation, " Staff spoke to resident in an inappropriate manner." It is alleged that on 11/04/2025, at approximately 12:10pm, S1 got upset when R1 requested R1’s meat to be cooked medium rare at the time of an upcoming dinner. S1 allegedly repeatedly yelled at R1 very loudly, telling R1 that R1 needed to leave. LPA interviewed R1 that corroborated with the allegation stating that S1 yelled at R1 and S1 got closer to R1. Additionally, there was one resident interviewed that observed staff in the past yelled at residents but could not provide specific details on the incident that occurred and did not corroborate this particular incident. LPA interviewed 14 out of 16 residents that could not corroborate the allegation stating that they have not witnessed S1 yell at R1 or any other resident. Most of the residents indicated that S1 treats residents with kindness and respect. One (1) out of 16 residents stated witnessing the incident on 11/04/2025 involving R1 and S1 and stated that S1 did not yell at R1. LPA interviewed the Executive Director and four (4) out of five (5) staff that denied the allegation stating that S1 did not speak inappropriately or yell at any residents. Two (2) of the five (5) staff interviewed stated witnessing the incident on 11/04/2025 involving S1 and R1 and stated that S1 did not yell or speak inappropriately to R1. LPA attempted to obtain video footage of the incident. However, the facility does not have any footage of the incident that occurred on 11/04/2025. LPA interviewed S1 that denied the allegation stating that on 11/04/2025, S1 and R1 were having a conversation trying to address R1’s concerns regarding the staff and S1 also indicated that S1 did not yell at R1. S1 has been employed since 06/24/2024 up until the present time and LPA did not observe any written warnings of S1 having inappropriate interactions with residents. Based on the facility’s internal investigation, they did not reveal any concerns regarding S1’s interactions with residents. Therefore, S1 was not suspended or terminated. LPA observed facility conducted a staff in-service training document as refresher dated 11/06/2025 which covered the topic on how to deal with residents in difficult situations. There is not enough supportive evidence to concur with the reported allegation.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.



An exit interview was held and a copy of this report was provided to the Executive Director, Jacqueline Briceno.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC9099 (FAS) - (06/04)
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