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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 10/07/2025
Date Signed: 10/07/2025 04:17:43 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
09/23/2025 and conducted by Evaluator Mayra Cota
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250923115304
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: 147DATE:
10/07/2025
UNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Jacqueline Cortez, Administrative DirectorTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Staff did not prevent resident from being harmed by another resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced subsequent complaint investigation visit to deliver findings on the above-mentioned allegation. Today’s visit stems from an initial visit conducted on 9/25/25. LPA met with Jacqueline Cortez, Administrator, and explained the reason for today’s visit.

The investigation consisted of the following:

During visit on 9/25/25, LPA obtained a copy of the staff and resident roster, reviewed Resident 1 and Resident 2's (R1-R2) file, obtained copies of relevant documents and conducted interviews with Staff 1-6 (S1-S6) and R2. During today’s visit, LPA toured common areas of the facility, obtained a copy of staff and resident rosters and conducted interviews with Resident 3 – Resident 8 (R3-R8) and telephonic interviews were conducted with R1 and (2) of R1’s family members.

The investigation revealed the following:
***Continues on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
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-20250923115304
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: 10/07/2025
NARRATIVE
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Regarding: Staff did not prevent resident from being harmed by another resident.

It is alleged that resident has been punched by roommate multiple times in which one incident resulted in a bruise on resident’s torso. It is also alleged that resident reported the incident to staff and asked to be moved to another room, but nothing was done.

Interviews with (6) out of (6) staff deny the allegation. Staff interviews indicated that R1 did not report an altercation with R2 which resulted in an injury to R1’s torso to staff. Staff stated that no other incidents between R1 and R2 have been reported by them to staff. Staff stated that R1 and R2 have disagreements from time to time about the volume on the television set being too loud or about the AC settings being too cold; however, disagreements do not escalade to physical aggression. S1- S4 indicated, R1 had been moved to another room after R1 made a request to administrative staff; however, R1 requested to be moved back to the room with R2. S1 and S2 indicated that when the change of room was granted for R1 to return to the room with R2, R1 was informing that requesting another room change may be difficult to undergo due to rooms not being available. Staff further indicated, when residents have altercations with their roommates, staff intervene by deescalating tension between them and providing the option to spend the night in an empty room to put space between residents. Furthermore, staff are mandated reporters, and any form of abuse is reported to ombudsman, licensing and or/law enforcement. Interview with R2 indicated that R2 did not hit R1 on the torso and has never hit R1. R2 stated, R1 and R2 sometime argue about the temperature in the room being too cold, but they have not hit R1 during their disagreements. R2 further indicated, their health is not good and cannot make jolting movements to hit another person. R2 stated, they suffer from joint pain and have had heart surgery in the past and cannot risk getting hit back by a person. Telephonic interview conducted with R1 indicated, R1 and R2 have argued about the temperature of the room which R2 likes to maintain in the coldest setting. R1 indicated, R2 punched R1 on the left side of their torso due to complaining to staff about the disagreements they have had about R2 setting the AC too cold and about R2 engaging in frequent sexual acts in R1’s presence. Two (2) of R1’s family members were also interviewed telephonically, and they indicated that R1 expressed concerns about R2 punching R1 in the torso as retaliation for R1 reporting R2 to staff. Family members also indicated that they saw the bruise on R1’s left side below the arm pit which looked like a fist mark. Record review indicated that R1 was moved to a secondary room after initial admission to the facility. Record indicates, R1 remained in the secondary room for a short period; but requested to return to the room R1 was initially installed in with R2.

Based on interviews and record review, the allegation could not be corroborated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Jacqueline Cortez, Executive Director, and a copy of this report was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
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