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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 10/20/2025
Date Signed: 10/20/2025 03:14:58 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/22/2025 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250522124740
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: 150DATE:
10/20/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Jacqueline Cortez – AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff do not properly dress a resident while in care.
Staff do not meet a resident's diapering needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent complaint visit to continue investigating the allegations listed above. LPA met with Jacqueline Cortez, Administrator and explained the purpose of the visit.

The investigation consisted of the following: On 05/29/2025 and 08/26/2025, LPA obtained copies of the staff/resident roster, Staff in service training about incontinence and hygiene care and Care staff assignment schedule, Resident #1 (R1) files such as: Face sheet (ID and Emergency Info.), Physician’s report, Admission Agreement, Functional Capability Information/Service Plan, Medication Administration Records (MARs)/list for April-May 2025, Care notes/charting, Xray result, Hospital discharge summary and Incident reports (SIRs) related to the allegations. LPA also interviewed Staff #1 (S1) - Staff #5 (S5).

During today's visit, LPA obtained copies of the staff/resident roster, reviewed pertinent documents related to the allegations and interviewed Resident #1 (R1) - Resident #15 (R15). ***CONTINUED ON LIC9099-C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
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-20250522124740
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SANTA ANITA ASSISTED LIVING
FACILITY NUMBER: 198603535
VISIT DATE: 10/20/2025
NARRATIVE
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The investigation revealed the following:

In regards to the allegation: “Staff do not properly dress a resident while in care”. It is alleged that the facility is not dressing R1 in clothes. No further information given. (5)of (5 ) staff interviewed denied the allegation. Staff interviewed stated that caregivers help all residents, including R1, with daily activities (ADLs) such as changing clothes. Staff stated that R1 is incontinent and has limited mobility, but staff assist R1 with dressing daily. Staff also stated they respect R1's personal choice to not wear pants at times, but ensure R1 never leaves the room without pants. Some staff indicated that R1 mentioned feeling comfortable using the urinal without pants as it is easier for R1. (15) out of (15) residents interviewed stated that staff assist them with activities of daily living (ADLs), like showering and changing clothes, and denied seeing anyone without clothing. R1 stated they feel comfortable and satisfied with their clothing and prefers not wearing pants at times because it is less troublesome when using the urinal. Other residents stated that they are comfortable with how the staff helps and treats them. During all the visits, LPA did not observe residents without clothing and residents appeared comfortable in their clothing. Therefore there was insufficient evidence to corroborate with the allegation.

In regards to the allegation: “Staff do not meet a resident's diapering needs”. It is alleged that the facility is neglecting R1 by leaving him in his adult diaper and not taking care of his personal care needs. (5) of (5) staff interviewed denied the allegation, stating that caregivers are properly trained in changing diapers. Staff stated that caregivers conduct regular rounds and change residents' diapers every two hours or as needed. Staff indicated that they manage their time to ensure all residents are changed on schedule and that there are enough incontinent supplies available. Out of (15) interviewed residents, (11) are incontinent and stated that they either change pull-ups themselves, only use them at night, or ask for staff assistance when needed. R1 stated a preference for staff assistance in the morning only, which the staff respect. Interviewed residents indicated that staff usually change their diapers on time, even though it may sometimes take a while for them to receive help. LPA observed staff doing rounds and taking care of the residents' needs during the visits. Therefore there was insufficient evidence to corroborate with the allegation.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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.

Exit interview conducted and a copy of this report was provided to Jacqueline Cortez, Administrator.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC9099 (FAS) - (06/04)
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