198603606-6-1-2026-28-AS-WSHO-DURR66-20260605124412

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603606
Report Date: 06/01/2026
Date Signed: 06/01/2026 12:59:27 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
05/25/2026 and conducted by Evaluator Mayra Cota

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260525161832

FACILITY NAME:	CLEARWATER AT GLENDORA		FACILITY NUMBER:	198603606
ADMINISTRATOR:	MICHELE JOHNSON		FACILITY TYPE:	740
ADDRESS:	333 W. DAWSON AVENUE		TELEPHONE:	(626) 885-0140
CITY:	GLENDORA	STATE: CA	ZIP CODE:	91740
CAPACITY:	148	CENSUS: 111	DATE:	06/01/2026
		UNANNOUNCED	TIME BEGAN:	09:23 AM
MET WITH:	Debbie Valdez, Executive Director		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff did not provide responsible party with resident's records in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Mayra Cota, conducted 10-day complaint investigation visit regarding the above-mentioned allegation. LPA met with Debbie Valdez, Business Office Director, and the reason for the visit was explained.

The investigation consisted of the following:

LPA obtained copies of staff and resident rosters, toured the facility, and conducted interviews with Staff 1 (S1) and (10) residents.

The investigation revealed the following:

***Continues on LIC 9099-C***

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

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-20260525161832

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: CLEARWATER AT GLENDORA	FACILITY NUMBER: 198603606
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/01/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/22/2026 Section Cited CCR 87468.1(a)(9)	1 2 3 4 5 6 7	87468.1(a)(9) Personal Rights of Residents in All Facilities: (a) Residents...shall have all of the following personal rights: (9) To have communications to the licensee from their representatives answered promptly and appropriately.	1 2 3 4 5 6 7	Licensee will submit plan for resident record requests to be conducted effectively and in a timely manner. The plan will indicated a description of staff duties for each step in the record request process. Licensee will email the plan to LPA by POC due date.
	8 9 10 11 12 13 14	This requirement is not met as evidence by: Written request for resident records (R1) was not followed up on in a timely manner due to inadequate communication from staff.	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.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260525161832

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: CLEARWATER AT GLENDORA	FACILITY NUMBER: 198603606
	VISIT DATE: 06/01/2026

NARRATIVE

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The investigation revealed the following:

It is alleged that resident’s responsible party has been attempting to obtain a copy of their records, but facility has not provided them even after requesting the record in writing. It is also alleged that responsible party has not been given any indication from the facility as to when they will receive them.

Interview with S1 indicated that the facility has a protocol in place for record requests. However, interview with S1 revealed that upon S1’s initial hire to the facility, S1 was still becoming familiar with the facility’s policies regarding resident document requests. When the initial request from R1’s responsible party was made to the corporate office to obtain R1’s records on 4/23/2026, S1 stated that they were waiting for corporate to follow-up due to S1 still becoming familiar with their role in the release of resident records. S1 stated that the facility did not refuse to provide R1’s responsible party with the requested records. S1 stated that R1’s responsible party eventually obtained R1’s records via email on 5/22/2026 during a visit they conducted to the facility. S1 stated that the facility does not have a specific turn-around time to follow up on record requests; however, S1 acknowledges that there was a communication breakdown and the request was not followed up by staff. S1 further indicates that staff communication could have been better and staff could have “acted quicker” to provide R1’s records to their responsible party. Interviews with (10) residents indicated that their needs are being met by facility staff and have no concerns regarding their care.

Interviews conducted corroborate the allegation that the facility did not provide R1’s responsible party with resident’s records in a timely manner. LPA substantiated the allegation above based on the evidence obtained during this investigation. A finding of substantiated means the allegation is valid because the evidence meets the preponderance of the evidence standard. LPA cited the deficiency below per California Code of Regulations (CCR) Title 22.

Exit interview was conducted with Debbie Valdez, Business Office Director, and a copy of the report, LIC 9099-D and Appeal Rights was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

LIC9099 (FAS) - (06/04)

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