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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603620
Report Date: 08/14/2025
Date Signed: 08/14/2025 12:37:58 PM

Substantiated


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
08/06/2025 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250806130010
FACILITY NAME:DAJAH'S HOME AFACILITY NUMBER:
198603620
ADMINISTRATOR:GONZALEZ, DIANAFACILITY TYPE:
735
ADDRESS:9937 EMERADO DRIVETELEPHONE:
(562) 536-2935
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:4CENSUS: 3DATE:
08/14/2025
UNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Joel Quezada - DSPTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Staff mismanaged resident's medications.
Staff does not properly store food.
Staff does not ensure resident's room is clean and sanitized.
Staff does not ensure facility plumbing is in good repair.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Erik Zaragoza and Gabriela Castro conducted an initial unannounced complaint visit to address the allegations listed above. LPAs met with Joel Quezada, Direct Support Staff, and explained the purpose of the visit. Administrator Diana Gonzalez arrived shortly thereafter.

The investigation consisted of the following: LPAs interviewed Staff #1 - 2 (S1 - S1), interview Client #1 (C1), reviewed the medications along with the medication administration records (MARs) for Clients #1 - 3 (C1 - C3), toured the room of C1, and reviewed a corrective action plan (CAP) from the East Los Angeles Regional Center (ELARC) dated 7/30/2025. LPAs were unable to interview C2 and C3.

The investigation revealed the following: In regards regards to the allegation "Staff mismanaged resident's medications," on 6/10/2025, there were multiple missed morning medcications for C3. [CONT. LIC9099-C page]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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 5
Control Number 28-AS-20250806130010
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: DAJAH'S HOME A
FACILITY NUMBER: 198603620
VISIT DATE: 08/14/2025
NARRATIVE
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During interviews with the clients, none of them corroborated the allegation. One client interviewed stated they have no issues with their medications. Another client was unable to be interviewed because they are currently hospitalized. During interviews with staff, two (2) out of two (2) corroborated the allegation. One of the staff interviewed stated that medication errors did occur on 6/10/2025, and that now they are utilizing a MARs issued from the clients' pharmacies to document medication passes. Another staff member stated that the PM medications for C3 were prepared in advance, and staff retraining on medication administration will be held on 8/25/2025. During review of MARs, it is noted that PM medications were prepared in advance which caused the medication errors. ELARC's CAP also indicated that medications for C3 were missed in the morning.

In regards the allegation that "Staff does not properly store food," it was alleged that meat that was stored in the fridge had spilled over onto other food items in the facility. During interviews with the clients, none of them corroborated the allegation. One of the clients interviewed stated that they don't typically check the refrigerator. The other clients were not available to be interviewed. During interviews with the staff, two (2) out of two (2) corroborated the allegation. One of the staff stated that staff now utilize a log to document observations of the refrigerator to ensure that it is kept clean. Another staff stated that bacon and hot dogs were not kept in their zip lock bags, and now the overnight staff are responsible for checking the refrigerator to ensure it is clean.

In regards to the allegation that "Staff does not ensure resident's room is clean and sanitized," it is alleged that C1's room had fecal matter left in their toilet due to the toilet not being operable, and that C1's clothes were left in their shower. During interviews with the clients, none of them corroborated the allegation. One client stated that they usually clean their room themselves, however if they ask for staff assistance to clean their rooms they do receive it. Other clients were not available to be interviewed. During interviews with the staff, two (2) out of two (2) corroborated the allegation. One of the staff stated that C1's bathroom did have fecal matter left in the toilet due to the plumbing issues. Another staff confirmed that C1's bedroom had been found with towels and clothes left on the floor and in the client's shower.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20250806130010
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: DAJAH'S HOME A
FACILITY NUMBER: 198603620
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/15/2025
Section Cited
CCR
80075(b)
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(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This regulation was not met as evienced by:
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**POC Cleared** Administrator is to ensure that medications are managed correctly for all clients at all times. Administrator is to submit the facility plan for staff retraining on medication administration to the LPA by the POC due date.
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Based on record review and interview, LPAs determined that PM medication for C3 was prepared in advance on the date of 6/10/2025, which poses an immediate health and safety concern for clients in care.
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Type B
08/21/2025
Section Cited
CCR
80076(a)(7)
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(a) In facilities providing meals to clients, the following shall apply: (7) Commercial foods shall be (...) free from contamination and spoilage and shall be fit for human consumption.

This regulation is not met as evidency by:
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**POC Cleared** Administrator is to ensure that food is kept free from contamination at all times. Administrator is to establish a refridgerator log which shall be checked by staff every night to ensure that it is clean, and email the log to LPA by the POC due date.
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Based on record record review and interview, LPAs determined that on 6/10/2025 juiced from a piece of meat had spilled over onto other foods in the facility refridgerator, which poses a potential health and safety concern for clients in care.
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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: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20250806130010
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: DAJAH'S HOME A
FACILITY NUMBER: 198603620
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2025
Section Cited
CCR
80087(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This regulation is not met as evidenced by:
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** POC Cleared** Administrator is to ensure that client's rooms are kept clean and sanitary at all times. Administrator is to clean C1's toilet and shower and ensure it is kept sanitized by the POC due date.
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Based on record review and interview, LPAs determined that on 6/10/2025 fecal matter and other bodily fluids was found in C1's toilet because it was not able to flush, and clothing was found in C1's restroom, which poses a potential health and safety concern to clients in care.
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Type B
08/21/2025
Section Cited
CCR
80088(e)(3)
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(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (3) All toilets, hand washing and bathing facilities shall be maintained in safe and sanitary operating condition.

This regulation was not met as evidenced by:
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**POC Cleared** Administrator is ensure that the toilets for all clients are maintained in operating condition at all times. Administrator is to have the toilet serviced and be operable by the client by the POC due date.
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Based on record review and interview, LPAs determined that on 6/10/2025 C1's toilet was not operable, which poses a potential health and safety concern to clients in care.
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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: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20250806130010
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: DAJAH'S HOME A
FACILITY NUMBER: 198603620
VISIT DATE: 08/14/2025
NARRATIVE
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In regards to the allegation that "Staff does not ensure facility plumbing is in good repair," it was alleged that C1's toilet was not able to flush for a period of time. During interviews with the clients, one (1) out of three (3) corroborated the allegations. One of the clients stated that their toilet was not functional for a period of time, however it is fixed now. None of the other clients were available to be interviewed. During interviews with the staff, two (2) out of two (2) corroborated the allegation. Both of them stated that C1's toilet was not operable, however a plumber has since come to the facility to fix the toilet. LPAs checked the toilet and found that it is now functional.

Based on LPA interviews conducted with the clients and staff, the preponderance of evidence standard has been met for the above allegations, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 1 is being cited on the attached LIC9099D pages.

Exit interview held administrator Diana Gonzalez. Exit interview was held and a copy of the report along with the appeal rights were provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5