198603535-10-28-2025-28-AS-RORN-DQZNLN-20260205093350

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 10/28/2025
Date Signed: 10/28/2025 05:09:29 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
10/24/2025 and conducted by Evaluator Luis DeLeon

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251024114624

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: 150	DATE:	10/28/2025
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Administrator Jacqueline Cortez		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff do not safeguard residents' personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Elena Mallett and Luis De Leon conducted an initial unannounced complaint investigation visit for the allegation listed above. LPA met with the Administrator Jacqueline Cortez and explained the reason for the visit.
The investigation consisted of the following: On today’s visit, LPA De Leon toured the physical plant and obtained the current resident and staff roster, Incontinence supply orders, physician’s reports, appraisals, and physician orders.
Regarding allegations: Staff do not safeguard residents' personal belongings.
It is alleged that staff are using incontinence supplies on residents from the personal supply of a second resident. It is also alleged that staff is using higher quality supply on residents who have orders of lower quality incontinence supplies. It is alleged that residents are not aware of staff placing orders for incontinence supplies using resident’s names.
Report continues on page LIC-9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025

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-20251024114624

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: 10/28/2025

NARRATIVE

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The investigation reveals the following: Staff interviews revealed that seven (7) out of seven (7) staff denied the above allegation. Two (2) out of two (2) staff responsible for coordinating residents’ supplies denied placing orders for residents personal incontinence supplies. S1 denied having access to supplier order system. Care Coordinator (S2) will send resident’s name list to supplier for those resident’s who need incontinence supplies. The supplier will get approval from doctors and insurance and will send incontinence supplies to facility based on quantity approved by insurance. Six (6) out of seven (7) staff stated that personal continence supplies for a resident are only used for that resident and no other resident. Resident interviews revealed that ten (10) out of ten (10) residents denied the above allegation. All residents stated that residents received their incontinence order and have access from their supply. All residents stated that they are not aware of staff using their personal incontinence supply to assist other residents. Through interviews and record reviews of residents who use incontinence supplies, ten (10) out of ten (10) residents received the supplies that were designated to residents. Based upon the investigation, resident and staff interviews, document review, and LPA observations, the licensee ensures that residents in care had their incontinence supply safeguarded and available to residents.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was held with Administrator Jacqueline Cortez. A copy of the report was provided

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025

LIC9099 (FAS) - (06/04)

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