198603550-8-4-2026-28-AS-FFIS-DWXMTA-20260814095309

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603550
Report Date: 08/04/2026
Date Signed: 08/04/2026 01:01:38 PM

Substantiated

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
07/30/2026 and conducted by Evaluator Elena Mallett

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260730100045

FACILITY NAME:	WEST PARK SENIOR LIVING		FACILITY NUMBER:	198603550
ADMINISTRATOR:	JERI MILES		FACILITY TYPE:	740
ADDRESS:	801 CYPRESS WAY		TELEPHONE:	(909) 592-8844
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	200	CENSUS: 126	DATE:	08/04/2026
		UNANNOUNCED	TIME BEGAN:	08:03 AM
MET WITH:	Administrator- Jeri Hillery		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is not conducting emergency drills

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) conducted an unannounced visit to the facility to investigate the above allegation. LPA met with Administrator Jeri Hilary and the purpose of the visit was explained.

Today's visit consisted of a tour of the facility and interviews with ten (10) staff and ten (10) residents. The following documents were collected; a staff and client roster, facility emergency disaster plan and a log of disaster drills conducted on 03/26/26 and 05/27/26..

Regarding the allegation facility is not conducting emergency drills, it is alleged that the facility has not conducted an emergency drill or evacuation drill in the last two years. Interviews with seven (7) out ten (10) staff members deny the allegation that facility are not conducting emergency drills. Interviews with (7) out of ten (10) staff members reveal that an emergency drill was conducted by the facility within the last three months. Per Administrator Jeri Hillery the facility has been conducting quarterly disaster drills but not with

Substantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026

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 3

Control Number 28-AS-20260730100045

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: WEST PARK SENIOR LIVING	FACILITY NUMBER: 198603550
	VISIT DATE: 08/04/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

all shifts. The drills were conducted with the morning shift, not the afternoon or NOC shifts.
Interviews with ten(10) out of ten (10) residents revealed that residents were not aware of the facility staff conducting any emergency drills. Interviews with ten (10) out of ten (10) residents revealed that residents were not aware of the facility staff conducting any emergency drills in the last three months. All of the residents interviewed stated the staff might have been conducting emergency drills but they the residents were just not aware of it.
LPA's review of the facility file showed that the facility has a Disaster Plan that was reviewed on 02/25/26 by the Administrator and logs of disaster drills conducted with employees on the am shift on 03/26/26 and 05/27/26.The facility has three shifts, an AM shift, PM shift and Noc shift. Per Health and Safety Code 1569.695 a facility shall conduct a drill at least quarterly for each shift. From LPA's facility record reviews and staff interviews it has been shown with a preponderance of the evidence that the facility is not conducting emergency drills with all shifts and this allegation is deemed substantiated.

An exit interview was conducted with Administrator Jeri Hillery and a copy of this Licensing Report along with Appeal right was provided. The facility was cited for Health and Safety Code 1569.695 during the annual visit on 01/21/26 so Civil Penalties in the amount of $250 will be assessed today.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20260730100045

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: WEST PARK SENIOR LIVING	FACILITY NUMBER: 198603550
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/04/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/12/2026 Section Cited HSC 1569.695(c)	1 2 3 4 5 6 7	1569.695 Emergency Plans (c) A facility shall conduct a drill at least quarterly for each shift...	1 2 3 4 5 6 7	By POC due date , Administrator will submit to LPA via office fax proof an emergency drillsconducted will all shifts.
	8 9 10 11 12 13 14	The above requirement was not met as the facility file did not contain documentation of quarterly emergency drills being conducted with the Pm and Noc shifts.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3