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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 08/15/2025
Date Signed: 08/15/2025 07:16:06 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
07/22/2025 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250722152959
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:
08/15/2025
UNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Alisa Dean, Business Office ManagerTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff mismanaged resident's medications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit for the allegation listed above. LPA arrived unannounced and met with the Business Office Manager, Alisa Dean, to explain the reason for the visit.

On 7/25/25, LPA Chan conducted the initial visit and interviewed Staff #1 - #5 and Residents #1 - #10. LPA obtained copies of the staff and resident rosters and reviewed medications for ten residents. Staff #6 - #8 were interviewed via telephone on another date.

The investigation revealed the following:
Allegation – Staff mismanaged resident’s medications. It is alleged that Resident #1 (R1) needed the Nitroglycerin pill but was told by staff that they had lost it.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
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 5
Control Number 28-AS-20250722152959
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: 08/15/2025
NARRATIVE
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During the visit on 7/25/25, LPA reviewed medications for ten residents. LPA observed all of R1’s medications in the med room, including the Nitroglycerin tablet, and they are managed by the staff. The Nitroglycerin medication is a PRN and is given to the resident upon request. LPA interviewed the medication staff regarding this allegation. One of the staff confirmed that the Nitroglycerin medication could not be found on 7/17/25 when R1 requested it. Staff stated another staff helped search for the medication but could not find it either, so R1 was sent out to the hospital. The staff on the next shift was able to locate the medication. Eight (8) out of ten (10) residents stated that the staff do not give them their medications on time and/or that they were missing.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 8), are being cited on the attached LIC 9099D.

An exit interview was conducted. The Plan of Correction was reviewed and developed with the administrator via telephone. A copy of this report and appeal rights were provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20250722152959
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: 08/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/16/2025
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.
This requirement is not met as evidenced by:
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The licensee shall submit a written plan explaining how PRN medications are stored and documented when given. The plan is due to LPA by 8/16/25.
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Based on interview, Staff could not find R1's PRN medication which poses an immediate health and safety risk to residents 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: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
07/22/2025 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250722152959

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:
08/15/2025
UNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Alisa Dean, Business Office ManagerTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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9
Staff do not ensure special diet plans are followed for residents in care.
INVESTIGATION FINDINGS:
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3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit for the allegation listed above. LPA arrived unannounced and met with the Business Office Manager, Alisa Dean, to explain the reason for the visit.

On 7/25/25, LPA Chan conducted the initial visit and interviewed Staff #1 - #5 and Residents #1 - #10. LPA obtained copies of the staff and resident rosters and reviewed medications for ten residents. Staff #6 - #8 were interviewed via telephone on another date.

Allegation – Staff do not ensure special diet plans are followed for residents in care. It is alleged that the facility does not serve heart-healthy and diabetic diets. In addition, the facility serves sugary drinks to all residents. LPA interviewed the Dietary Director, who stated that the meals served to residents contain minimal sugar and salt. Residents have the option to add more seasoning on their own.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20250722152959
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: 08/15/2025
NARRATIVE
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The meal plan is created with residents’ suggestions and their dietary needs. The cooks stated they include servings from the different food groups and ensure there are alternatives each day. Staff stated they follow any special diets that each resident may have. If a resident’s dietary needs change, the kitchen staff are informed right away. Staff interviewed also stated there are sugar-free drinks and desserts available for residents. Staff provide sugar-free drinks and desserts to those who are diabetic; however, if they choose to get the regular ones, staff will give to them even though they remind them they should not consume sugary items. During the kitchen tour on 7/25/25, LPA observed sufficient food supplies with fresh vegetables and sugar-free drinks and desserts. The kitchen has a list of residents who have dietary needs/restrictions and are diabetic. Two (2) out of (10) residents interviewed feel that the facility does not have sugar-free drinks and desserts, and the food is cooked with lots of sugar. Eight of the residents stated the facility serves sugar-free items and offers a variety of food.


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.

An exit interview was conducted with the administrator via telephone. 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: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5