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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603606
Report Date: 07/07/2026
Date Signed: 07/07/2026 01:54:50 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
06/29/2026 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260629161155
FACILITY NAME:CLEARWATER AT GLENDORAFACILITY NUMBER:
198603606
ADMINISTRATOR:MICHELE JOHNSONFACILITY TYPE:
740
ADDRESS:333 W. DAWSON AVENUETELEPHONE:
(626) 885-0140
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:148CENSUS: 111DATE:
07/07/2026
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:William Boles – Executive DirectorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not keep resident from being inappropriately touched by another resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the reported allegations. LPA met with Executive Director William Boles and explained the purpose of today's visit.

The investigation consisted of the following:
LPA obtained copies of staff/resident rosters, Face Sheet and Special Incident Report for Resident #1, conducted interviews with Local Law Enforcement, 1 Witness (W1), 5 Staff (S1-S5), 5 Residents (R1-R5) and toured the Memory Care wing at facility that has a current census of 38.

(continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
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-20260629161155
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: CLEARWATER AT GLENDORA
FACILITY NUMBER: 198603606
VISIT DATE: 07/07/2026
NARRATIVE
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The investigation revealed the following:
Allegation: Staff did not keep resident from being inappropriately touched by another resident.
It is alleged that on 5/3/26 facility staff did not maintain a safe environment resulting in R1 being sexually assaulted by R2 at the facility. LPA interviewed Local Law Enforcement who also investigated this allegation and they informed LPA that the outcome was a DA reject due to both individuals having a diagnosis of dementia and both residents having cognitive disabilities that make it difficult to determine if either of the residents knew what they were doing was/is wrong or inappropriate. LPA interviewed R2 in their private room and they denied the allegation, R2 stated they don’t touch people, have never assaulted anyone and has never had anyone assault them. LPA interviewed R1, they denied the allegation, stating that they have never been assaulted and feel safe at the facility. Interviews with R3-R5 were conducted and each resident denied the allegation and stated that they have never been touched inappropriately and feel safe at the facility. LPA conducted interviews with 5 staff and each denied the allegation, staff stated that although R1 and R2 are often very friendly with each other and seem to enjoy each other’s company there was no thought of this being assault. S3 stated that although the incident of both residents being R2’s room and touching each other’s arms did happen there was nothing during their investigation to determine this as sexual assault. Interviews with S3-S5 revealed that staff are aware that R1 and R2 are friendly with each other and are monitored to ensure they are not in each other’s private rooms, if both residents are not observed in the common areas staff will conduct rounds to ensure both are safe and not left unattended inside of one their rooms. LPA interviewed 1 witness and they stated during their visits they have seen R1 and R2 speaking and interacting in common areas such as dining and activity area, however, they have never seen them touching or left alone in an unattended area. Additionally, LPA toured memory care wing to ensure both R1 and R2’s bedrooms are not neighboring each other and there is sufficient space separating both rooms and are on opposite ends.

Based on statements and interviews conducted with staff/residents/witnesses, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
LIC9099 (FAS) - (06/04)
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