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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 09/11/2025
Date Signed: 09/11/2025 04:33:20 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/12/2025 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250612164021
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:
09/11/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Jacqueline CortezTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff pushed a resident in care.
Staff spoke to residents in an inappropriate manner.
Staff threatened a resident in care.
Staff did not serve a meal to resident in a timely manner.
Staff did not ensure that resident's medical needs are being met.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman, made an unannounced subsequent complaint visit in response to the above mentioned allegations. LPA met with Jacqueline Cortez, Administrator, and explained the purpose of the visit.
The initial visit was conducted on 06/19/2025 and the following was done:
LPA obtained a copy of the staff and resident roster, Special Incident Report's (SIR's), and Staff Communication Notes.
Interviewed Residents 1-4 ( R1-R4) and Staff 1-2 (Staff S1- S2)
File was reviewed for Resident R1 and various documents were submitted.
At today's visit interviews were conducted with Resident's R5- R10, the Administrator and Staff S3.
In regards to the allegations Staff pushed a resident in care, Staff spoke to residents in an inappropriate manner, Staff threatened a resident in care based in interviews conducted and information gathered 9 of 10 residents interviewed stated that staff have not been inappropriate with the residents.All stated that if anything the residents are the aggressors.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
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-20250612164021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SANTA ANITA ASSISTED LIVING
FACILITY NUMBER: 198603535
VISIT DATE: 09/11/2025
NARRATIVE
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They also stated they have not seen or heard of physical, or verbal abuse and no one has been threatened by the staff.
Interview with Resident R10 who stated that R1 has been the aggressor toward Staff S3. Will also call Staff S3 and other staff racist words and seems like R1 has a vendetta toward S3. Said S3 is kind to all the residents.
Interview with Staff S2 who said R1 is extremely mean and calls her the B word and she doesn't respond.
No one pushed, yelled or threatened R1. If anyone does that it is her. R1 harasses staff and residents.
Staff S3 stated R1 is the aggressor and said there has never been pushing, threatening or speaking inappropriately to R1 or any resident.
The Administrator stated that Staff S3 didn't push R1. R1 harasses and calls S3 the B word.
Said S3 is kind to all the residents.
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.

In regards to the allegation Staff did not serve a meal to resident in a timely manner, based on interviews conducted and information gathered 9 out of 10 residents stated the food service is good and that they are all served pretty quickly for all 3 meals. Said the staff organize alot of residents very efficiently. The Administrator stated that there are multiple servers and the system is very good. Staff S1-S3 said the servers are very efficient and the process moves very fast for all 3 meals. Staff S3 stated that there is a red line in front of the kitchen and it says not to cross it because it's only for employees. Said R1 attempted to get in the kitchen 3x and service had just started when R1 said out loud I'm waiting 45 minutes.

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.

In regards to the allegation Staff did not ensure that resident's medical needs are being met, based on interviews conducted and information gathered 9 out of 10 residents stated that staff will give immediate attention if it may be urgent and will call 911 right away.

Said if they call for help staff come quickly. Said staff will arrange doctor appointments. R1 confirmed that facility arranged for her to go to the hospital after an unwitnessed fall. LPA during initial visit conducted on 06/19/2025 observed R1's call button to be operable. Resident R11 had been treated by Home Health and had gone to the hospital 06/18/2025 and moved out of the facility on 07/03/2025. Resident R6 stated that she had fallen and injured her foot and the staff came immediately after pressing the call button.

Staff S1- S3 all stated that residents are helped right away and they call for assistance from the call button in their room. Said they also help immediately if they see the resident in need of medical attention.

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.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/12/2025 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250612164021

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:
09/11/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Jacqueline CortezTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Call button in bedroom is inoperable
INVESTIGATION FINDINGS:
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In regards to the allegation Call button in bedroom is inoperable based on interviews conducted, tour of resident rooms and information gathered it was revealed in interviews conducted that Resident R7 and Resident R9 stated that their call button is not working properly.
During tour of R7 and R9's room with the Administrator LPA observed that when the call button was pressed for both residents there was no response from a staff member answering..
Administrator confirmed that the call button for R7 and R9 when pressed was not answered by staff.
Also stated that they were already in touch with a company that will repair it.
It should be noted that the call button for R1 was operable at initial visit conducted on 06/19/2025.

Based on LPA observation and 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.
Exit interview conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20250612164021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 09/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
09/12/2025
Section Cited
CCR
87303(i)(1)(A)(B)(C)
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Maintenance and Operation
Facilities shall have signal systems which shall meet the following criteria:
(1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall:
(A) Operate from each resident's living unit.
(B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff.
(C) Identify the specific resident living unit.
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Facility to submit by POC due date verification of a scheduled appointment with a company to repair call buttons.
Also to submit receipts when the work is
completed.
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This requirement is not met as evidenced by:
Facility failed to have a signal system operable in R7 and R9's room 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: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4