198603535-12-2-2025-28-AS-RORN-DQ4U6Y-20260107141907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 12/02/2025
Date Signed: 12/02/2025 05:06:39 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
11/26/2025 and conducted by Evaluator Mayra Cota

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251126131229

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: 146	DATE:	12/02/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Jacqueline Cortez, Executive Director		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff do not ensure emergency drills are conducted.
Staff do not ensure facility is clean and sanitary.
Staff do not follow food service sanitation practices

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Mayra Cota, conducted an unnanounced 10-day complaint visit to investigate the above-mentioned allegations. LPA, met with Jacqueline Cortez, Executive Director and the reason for the visit was explained.

The investigation consisted of the following:

During today's visit, LPA, obtained copies of staff and resident rosters, toured the facility with a focus on inspecting the kitchen and (2) dining rooms, conducted interviews with Staff 1 - Staff 13 (S1-S13) and Resident 1 - Resident 13 (R1-R13), counducted record review and obtained copies of Fire Drill Reports for June - November 2025 Fire Drill Reports and Personal Hygiene: Head Covering policy and procedures. LPA also conducted observation of meal services during today's visit.

****Continues on LIC-9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

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 4

Control Number 28-AS-20251126131229

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: 12/02/2025

NARRATIVE

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The investigation revealed the following:

Regarding: Staff do not ensure emergency drills are conducted.

It is alleged that staff never conduct any fire drills and that although the alarm is tested, staff do not evacuate the residents or conduct any drills.

Staff deny the allegation. Interviews with (13) out of (13) staff revealed that fire drills are conducted every month and are trained in safety procedures. Staff indicated that earthquake, active shooter and evacuation drills are conducted interchangeably during the monthly fire drills. Eight (8) staff indicated that the drills also include training on keeping safe during gas leaks and grease fires, and how to safely evacuate staff and residents if ever needed. Staff further indicated that staff conduct inspections of fire extinguishers, smoke and carbon monoxide detectors, and test the fire alarms monthly. S1 stated that resident participation is welcomed and encouraged, and a few residents participate in the drills and evacuation procedures even though their participation is not mandatory. S1 further stated that all facility staff must take safety in-service trainings and if on shift, must participate in the monthly drills. Interviews with (10) out of (13) residents revealed that they observe the facility staff conducting fire drills every month. Two (2) out of (13) residents indicated that they have not seen fire drills taking place because they don’t leave their room most of the day. Interview with (1) out of (13) residents indicated that facility staff do not conduct fire drills nor evacuate residents; however, a review of records by LPA indicated that the facility conducts fire drills every month by a contracted vendor with staff participation who is on shift. Record review further indicated that fire alarms, doors, extinguishers, shut off valves, and exit routes are checked and tested during the monthly drills.

Staff and resident interviews and record review do not corroborate the allegation that staff never conduct fire drills and do not evacuate the residents.

Regarding: Staff do not ensure facility is clean and sanitary.

It is alleged that on 11/25/25, resident saw egg particles from breakfast on the dining room table while resident was having lunch and that this happens a lot.

Staff deny the allegation. Interviews with (8) out of (13) staff revealed that tables and chairs are cleaned before, after and as needed between every meal service. Staff stated that tables are cleaned after being used by residents but will wait for residents who take longer to eat than others before initiating cleaning the tables.

***Continues on LIC 9099-C page 2

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20251126131229

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: 12/02/2025

NARRATIVE

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Staff indicated that they have not observed any tables left with egg or other food particles nor have they received any complaints from residents regarding tables being left dirty with food particles. Staff further indicated that staff follow policy and procedures regarding proper cleaning and disinfecting of tables and chairs and that kitchen grade sanitation liquid and hot water is used to clean tables and chair surfaces. Interviews with (5) out of (13) staff indicated that they are not familiar with the table cleaning procedures the kitchen has in place; however, they have not observed the tables with food particles before or after meals are provided nor have, they received any complaints from residents regarding the dining room tables being dirty. Interview with (2) out of (13) residents indicated that they have observed tables being left dirty with egg and cherry pie stains in between the breakfast and lunch meal service. However, interviews with (11) out of (13) residents indicated that they have not observed food particles on left on the tables before they sit down to eat and do not have any concerns regarding tables not being cleaned by staff. After breakfast and lunch ended, LPA inspected all tables in the facility’s two dining rooms and did not observe any food particles on the tables. LPA, also observed staff cleaning the two dining rooms including the tops of the tables after breakfast and lunch. After cleaning was conducted by staff, LPA conducted another inspection of all the tables in the two dining rooms before the dinner services began and did not observe any food particles on the tables. Staff and resident interviews and LPA observations could not corroborate the allegation that tables are left with food particles.

Regarding: Staff do not follow food service sanitation practices.

It is alleged that one kitchen staff does not wear a hair net and that staff serves food and people are getting hair in their food.

Staff deny the allegation. Interviews with (8) staff indicated that kitchen staff who work in the preparation and cooking of food always wear hair nets. Staff indicated that they follow policy regarding safe and sanitary food handling and are trained in maintaining proper hygiene. Staff further indicated that although policy indicates that servers are not mandated to wear hair nets, staff use them to prevent hair from falling into residents’ food. Staff also indicated that caps can be used to protect food from hair or other things from falling in. Interview with one server staff indicated that they wear a hair net even though policy states they do not have to wear one. Staff interviews further indicated that residents have not expressed concerns regarding staff not wearing caps or hair nets during meal services or finding hair in their food. Interview with R1 indicated that R1 has observed one server staff not wearing a hair net and that other people have had hair in their food. However, during interview,

***Continues on LIC 9099-C page 3

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20251126131229

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: 12/02/2025

NARRATIVE

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R1 did not provide names of other people who R1 states have had concerns about one server staff not wearing a hair net during meal services. Interviews with (12) out of (13) residents revealed that they have no concerns regarding staff following food services and sanitation practices like wearing hair nets during meal service and have not found hair in their food. LPA observation of today’s breakfast and lunch meal service indicated that staff handling food were wearing caps and hair nests. LPA further observed that all the servers in the dining rooms were all wearing hair nets. Record review of the facility’s hygiene policy indicated that only cooks are required to wear hair nets or caps; however, servers do not have to wear them but are encouraged to do so. Interviews with staff, residents, observations and record review do not corroborate the allegation that one server staff does not wear a hair net and people are getting hair in their food.

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 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: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4