198603535-9-18-2025-28-AS-WSHO-DR78N9-20260210213934

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 09/18/2025
Date Signed: 09/18/2025 12:47:46 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
09/12/2025 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250912092956

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: 149	DATE:	09/18/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jacqueline Cortez		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not seek medical assistance for resident in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman, made an unannounced complaint visit in response to the above mentioned allegation. LPA met with Jacqueline Cortez, Administrator, and explained the purpose of the visit.
At today's visit LPA obtained a copy of the staff and resident roster, and Staff Communication Notes.
Interviewed Residents 2-8 ( R2-R8) and Staff 1-2 (Staff S1- S2). Administrator also interviewed.
File was reviewed for Resident R1 and various documents to be submitted which included Physician's Report, Admissions Agreement and Emergency ID page.
In regards to the allegation Staff did not seek medical assistance for resident in a timely manner, based on interviews conducted and information gathered Resident's R2-R5 all stated that they have had to go to the hospital and staff acted appropriately by calling 911 immediately. Stated the whole process of going to the hospital and back to the facility went smoothly.
Resident's R6-R8 stated that staff assist with any medical needs. Stated that they have observed residents
in need of medical assistance and the staff act quickly and if needed call 911 right away.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

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-20250912092956

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: 09/18/2025

NARRATIVE

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R7 and R8 said they have gone to the hospital and 911 was called immediately and that staff communicates well and the process has gone smoothly.
Spoke with Administrator who stated Resident R1 had an unwitnessed fall and was assessed.
Stated R1 didn't have a head injury and everything was normal.
Said R1 normally has slurred speech.
Interview with Staff S1 who stated that R1 fell and was assessed right away and had no head injury, and no wounds. Vitals were normal. Said all was normal with R1. Stated slurred speech is normal. It is baseline.
Interview with Staff S2 who stated that if resident had fallen they don't just send them to the hospital. They assess and with R1 didn't have a head injury or wound.
Stated R1 was oriented x4 and R1 is self responsible and was fine and didn't want to go to the hospital.
Admissions Record dated 2/19/24 lists R1 as responsible party.
Staff communication notes state that on 09/09/25 at 12:10 AM that R1 was on the floor. Also said that there were no bumps or bruises and R1 didn't hit head or have any pain.
It should be noted that R1 is currently in the hospital.

Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are unsubstantiated.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

LIC9099 (FAS) - (06/04)

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