<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 08/18/2025
Date Signed: 08/18/2025 03:13:29 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
06/06/2025 and conducted by Evaluator Mayra Cota
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250606124958
FACILITY NAME:SANTA ANITA ASSISTED LIVINGFACILITY NUMBER:
198603535
ADMINISTRATOR:JOEL NIBBLETFACILITY TYPE:
740
ADDRESS:5600 GRACEWOOD AVENUETELEPHONE:
(626) 442-8410
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY:150CENSUS: DATE:
08/18/2025
UNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Jacqueline Cortez, Executive DirectorTIME COMPLETED:
03:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure medications are inaccessible to others in care.
Staff do not follow proper food handling practices.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst, Mayra Cota, conducted subsequent complaint investigation visit to deliver findings for the above mentioned allegations. LPA met with Jacqueline Corez, Executive Director and the reason of the visit was explained.

The investigation consisted of the following:

LPA, toured common areas of the facility, including the kitchen and dining room, conducted interviews with Staff 1 - Staff 13 (S1-S13) and Resident 1 - Resident 14 (R1-R14).
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
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 3
Control Number 28-AS-20250606124958
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: 08/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding: Staff do not ensure medications are inaccessible to others in care.

It is alleged that staff often leave medications unattended in the dining room. It is alleged that a resident was given medication by Med-Tech staff; however, the resident did not take the medication and the medication remained on the table in the cup for over an hour. It is also alleged that this was not the first instance of medications being left accessible and unattended in the dining area.

The investigation revealed the following:

Thirteen (13) out (13) staff deny the allegation. Interviews with staff indicated, they have not observed medication left accessible and unattended in the dining room nor have they observed medication left accessible and unattended in any other location in the facility. Eight (8) staff stated that medication administration procedures require medication technicians to provide scheduled medications to residents in a small cup and provide them with drinking water and supervise the residents as they take it. Staff stated technicians cannot walk away from residents until they ensure residents consume their medications whether taken in the dining room, their rooms or anywhere else in the facility. Staff visually check to see if residents swallow medication before moving on to assist the next resident with their medication. If residents want to wait on taking their medication, staff cannot leave scheduled medication with residents. Staff take back medications, lock them in the medication cart and inform residents they will come back to give them their medication when they are ready to take it. Interviews with (12) out of (14) residents indicated they have not observed medication left unattended and accessible to residents in the dining room by staff nor have they observed medication left accessible to residents and unattended in any other location in the facility. Ten (10) residents who need assistance with medication administration stated, staff wait for residents to take their medication before they walk away and take back any medication not taken at the time. One (1) of (14) residents did not provide information regarding this allegation.

****Continues on LIC 9099-C page 2

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250606124958
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: 08/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding: Staff do not follow proper food handling procedures.

It is alleged that resident noticed a long black hair in resident’s baked potato and stated that roommate does not have black hair.

Staff deny the allegation. Interviews with (13) out of (13) staff indicated that residents have not complained about observing hair in the food prepared and provided by the facility’s kitchen. Interviews with eight (8) staff indicated that it is mandatory for staff handling food during preparation and service to use gloves and hairnets to prevent foreign objects from falling into the food. Staff further stated hand washing practices are always enforced. Food handling gloves are changed between handling different food items to ensure safe food handling practices. Food is covered with plastic film or refrigerated to avoid anything falling into it before it is served. Staff stated cutting boards are specifically assigned for the preparation of all proteins and all surfaces are cleaned and disinfected before and after use. All staff monitor food as it is going out for consumption to ensure freshness. Twelve (12) out of (14) residents indicated, they have never observed hair in their food when taken in the dining room or when it’s delivered to their room by staff. Residents stated the food is well prepared and during visits to the dining room, kitchen staff are observed wearing hair nets and food gloves. One (1) out of (14) residents did not provide information regarding this allegation. During tour of the kitchen and dining area, LPA observed staff wearing hair nets and food handling gloves during food preparation and service to residents. Food which was ready to be served was observed covered before servers brought it out to the residents in the dining area. LPA observation also indicated, meal trays on the kitchen carts which were ready to be delivered to resident's rooms, were also individually covered. Interviews with staff and residents and LPA observations do not corroborate the allegation.

Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3