198603623-5-29-2026-28-AS-FFIS-DWPSMR-20260806140021

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603623
Report Date: 05/29/2026
Date Signed: 05/29/2026 04:10:09 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
05/21/2026 and conducted by Evaluator Elena Mallett

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260521111250

FACILITY NAME:	LOVING ARMS RESIDENTIAL CARE FOR SENIOR III		FACILITY NUMBER:	198603623
ADMINISTRATOR:	CYNTHIA PABALAN		FACILITY TYPE:	740
ADDRESS:	11511 THOMAS PLACE		TELEPHONE:	(562) 864-6308
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	6	CENSUS: 2	DATE:	05/29/2026
		UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Administrator Cynthia Pabalan		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are not accepting resident back to facility

INVESTIGATION FINDINGS:

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Licensning program Analyst( LPA) Elena Mallett conducted an unannounced l Complaint investigation to investigate the above allegation. LPA was met by staff in charge Alfredian Sanedrin and the purpose of the visit was explained. Administrator Cynthia Pabalan was contacted by telephone and joined the visit shortly after.
The investigation consisted of the following: LPA toured the physcial plant, interviewed four staff , including Administrator and reviewed three resident files. LPA obtained a current staff and resident roster and Resident 1's(R1) Admissions Agreement, Emergency Identification Sheet, Physician's Report, government ID, Preplacement Apprasial Infomration, Appraisals needs and Service Plan and Hospice Notes, Hospice visit schedule, Hospice face sheet and List of Hospice team.There were no immediate health and safety concerns observed during the tour of the physical plant.
Regarding the allegation:Staff are not accepting a resident back to facility. It is alleged that R1 was not accepted back at the facility following the completion of a hospital stay. R1 was admitted to the hospital

Substantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026

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-20260521111250

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: LOVING ARMS RESIDENTIAL CARE FOR SENIOR III	FACILITY NUMBER: 198603623
	VISIT DATE: 05/29/2026

NARRATIVE

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and was not permitted to return to facility upon discharge. Four (4) out of four (4) staff confirm R1 did not return to the facility after hospital stay. One(1) out of (2) residents confirmed R1 did not return to the facility after hospital stay. Three (3) out of three (3) witnesses confirm R1 did not return to the facility after R1's hospital stay. Administrator states that R1 was not accepted back at the facility due to requiring a higher level of care than the facility could provide. Interviews with family members corroborate that the reason the Administrator gave for not accepting R1 back at the facility following R1's hospital stay was that R1 required a higher level of care than the facility could provide. LPA reviewed R1's file and the care required by R1 was noted. LPA asked Administrator to provide documentation that showed upon leaving the hospital R1 required a higher level of care than what had been required when R1 was initially retained at the facility but Administrator did not provide any further documentation.
The investigation revealed that staff are not accepting resident back at the facility.

Based on LPA’s record review and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiency cited on the attached LIC 9099D per Title 22 regulations. An exit interview was conducted with Administrator Cynthia Pabalan and a copy of this Licensing report was provided along with the Appeals Rights.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Elena Mallett
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260521111250

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: LOVING ARMS RESIDENTIAL CARE FOR SENIOR III	FACILITY NUMBER: 198603623
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/29/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/30/2026 Section Cited CCR 87468.2(a)(20)	1 2 3 4 5 6 7	87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition... Residents in All Facilities, (a) residents... have all of the following personal rights: (20) To be protected from involuntary transfers, discharges, and evictions. ...	1 2 3 4 5 6 7	By POC due date Administrator will provide LPA with a signed statement of understanding of cited regulation sent to the Office fax.
	8 9 10 11 12 13 14	The above requirement was not met as evidenced by R1 was not permitted to return to the facility after a hospital stay. Documentation did not support that the facility could no longer provide sufficient level of care.	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: 05/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026

LIC9099 (FAS) - (06/04)

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