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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 10/24/2025
Date Signed: 10/24/2025 12:45:20 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:
10/24/2025
UNANNOUNCEDTIME BEGAN:
10:39 AM
MET WITH:Jacqueline Cortez - Executive DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not seek timely medical attention for a resident.
Staff did not timely provide a resident's medical results.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent complaint visit to deliver findings for the allegations listed above. LPA met with Jacqueline Cortez, Executive Director and explained the purpose of the visit.

The investigation consisted of the following: LPA conducted visits on 05/29/2025, 08/26/2025 and 10/20/2025 and 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 interviewed Staff #1 (S1) - Staff #5 (S5), Resident #1 (R1) - Resident #15 (R15) and had delivered findings for the other allegations.
*****CONTINUED ON LIC9099-C*****
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
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 2
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: 10/24/2025
NARRATIVE
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The investigation revealed the following:

Allegation: “Staff did not seek timely medical attention for a resident.” It is alleged that R1 fell, hurt their ankle and had a mobile x-ray but the results were not provided on time which showed R1 had a fracture. Allegedly, this delay might have led to receive care late and further injury to R1’s fracture. Interviewed staff denied the allegation and stated that staff respond quickly to residents needing medical help. Some staff interviewed explained their procedure that, when they first become aware of the resident's change in condition or if they suffer an injury, caregivers report it to med tech, who assess, document, and notify the physician and family. And for serious injuries, they call 911. Staff indicated they have sufficient staff and training to recognize changes in residents' conditions. S1 stated that when R1 fell, a staff member assisted R1 immediately, who refused to be taken to the hospital and did not report pain or symptoms later. R1 confirmed that when they fell, staff assisted them immediately and that they declined to be taken to the emergency room because they thought it was not a big deal. (13) out of (15) residents interviewed indicated that staff assist them when they need medical attention or have been injured. Some residents indicated that staff would order medical tests for them if needed or requested. Interviews and reviewed documentation do not corroborate this allegation.

Allegation: “Staff did not timely provide a resident's medical results” It is alleged that R1 had a mobile x-ray for an ankle injury three weeks ago (end of Apr 2025), but R1 only got the results two days (3rd week of May 2025). (5) of (5) staff interviewed stated that they do not read or interpret xray findings because they are not radiologists. S1 indicated that licensed medical professionals like doctors and radiologists are qualified to interpret x-rays. Interviewed staff also stated that R1's doctor is responsible to go over the x-ray results with them. Staff stated that they helped R1 by scheduling and coordinating with a mobile x-ray service that comes to the facility. Reviewed files showed that R1's family member is the responsible party who is involved in care decisions, communicating with R1's doctors and authorized to receive R1's medical results. Interviewed residents indicated they had medical tests done at the facility and their doctors explained the findings to them and some ask the staff to check if results are ready before contacting their doctors. Documentation reviewed and interviews conducted do not corroborate this 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, Executive Director.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
LIC9099 (FAS) - (06/04)
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