198603535-10-6-2025-28-AS-FFIS-DN529Z-20251104161245

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 10/06/2025
Date Signed: 10/06/2025 04:16:47 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
09/22/2025 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250922121137

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: 147	DATE:	10/06/2025
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Jacqueline Cortez, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff spoke to resident in an inappropriate manner.
Staff threatened to withhold resident’s medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit for the allegations listed above. LPA met with Administrator Jacqueline Cortez to explain the purpose of the visit.

On 9/30/25, LPA Chan obtained copies of the staff and resident rosters and interviewed the administrator and a staff. During the visit today, LPA interviewed an additional four (4) staff and ten (10) residents.

The investigation revealed the following:
Allegations - Staff spoke to the resident in an inappropriate manner. It is alleged that a staff “screamed her bloody head off, ahh” after observing an extra plate of food on the resident’s walker and “acted like a B.” LPA interviewed staff and residents regarding this allegation. Administrator and Staff stated they are provided training on ways to communicate with residents, and they do not speak to residents inappropriately.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025

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-20250922121137

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: 10/06/2025

NARRATIVE

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Staff do not yell at residents or make inappropriate comments. Staff treat residents with dignity and respect. LPA interviewed the administrator, who stated that it was brought to her attention and written statements from staff were provided for this incident. Per the statements, S1 knocked on the door and went inside the room to take out the trash. The resident started to yell, so the staff took out the trash and closed the door. LPA interviewed S1, who denied making any statements/comments to the resident while in the room. The other staff who was present confirmed that S1 did not talk back to the resident. Nine (9) out of ten (10) residents have not been spoken to inappropriately by the staff. Residents stated that staff are respectful and do not put them down.

Allegation - Staff threatened to withhold the resident’s medication. It is alleged that the staff threatened to withhold the resident’s medication if the resident did not treat the new girl nicely. LPA interviewed the administrator and staff who had not heard any staff threatening the residents. Staff stated they are not allowed to and do not threaten residents to get them to comply or to treat others kindly. Nine (9) out of ten (10) residents stated they have never been threatened by the staff or seen staff threatening others.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are UNSUBSTANTIATED.

An exit interview was conducted with the administrator. A copy of this report, along with the appeal rights, was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025

LIC9099 (FAS) - (06/04)

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