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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603709
Report Date: 07/22/2025
Date Signed: 07/22/2025 12:15:30 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
07/17/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250717150019
FACILITY NAME:JOURNEY TOGETHER MOLINEFACILITY NUMBER:
198603709
ADMINISTRATOR:ARGUELLES, NELSONFACILITY TYPE:
735
ADDRESS:12239 MOLINE DRIVETELEPHONE:
(562) 325-8418
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:4CENSUS: 4DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Administrator Nelson ArguellesTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Facility did not keep accurate record of client medication.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs) Kimberly Ramirez and Gabby Castro conducted an unannounced initial complaint investigation visit on 07/22/2025 to regarding the above allegation. During today’s visit, LPA Ramirez was greeted by Administrator Nelson Arguelles and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster (LIC 9020), Staff#1 (S1), copies of Client#1 (C1): physician’s order dated 5/01/25 & 6/3/25, medication administration record (MAR) dated June 2025, copies of Client#2 (C2): medication administration record (MAR) dated December 2024, Corrective Action Plan (CAP) dated 6/3/25, training material for Corrective Action Plan, and physical plant tour.

SEE 9099-C
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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-20250717150019
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: JOURNEY TOGETHER MOLINE
FACILITY NUMBER: 198603709
VISIT DATE: 07/22/2025
NARRATIVE
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The investigation revealed the following: regarding the allegation “Facility did not keep accurate record of client medication.” It is alleged staff did not accurately record medication administered to C2 on 12/2/2024. On 7/22/25, LPA Ramirez conducted a review of C2’s medication administration record (MAR) dated December 2024, and it revealed on 12/2/2024 C2 was administered their medication according to their physician’s orders, however, staff did not complete MAR to document medication administration. Review of Corrective Action Plan (CAP) dated 6/3/25, corroborated this allegation. The interview with Administrator Arguelles corroborated this allegation. Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

One (1) deficiency was cited during this complaint investigation. Exit interview was conducted. A copy of this report was provided via email.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20250717150019
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: JOURNEY TOGETHER MOLINE
FACILITY NUMBER: 198603709
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2025
Section Cited
CCR
80070(a)
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Client Records
(a) The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client.
THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY:
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*NO FURTHER ACTION REQUIRED* Administrator completed staff re-training on 12/7/24 and 7/10/25 on client records and reporting requirements. LPA Ramirez requested and obtained copies of staff attendance and training material.
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Staff did not ensure C2'S Medication Administration Record for 12/2/2024 was complete and current. This poses a potential risk to the health, safety, or personal rights of persons 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.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
07/17/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250717150019

FACILITY NAME:JOURNEY TOGETHER MOLINEFACILITY NUMBER:
198603709
ADMINISTRATOR:ARGUELLES, NELSONFACILITY TYPE:
735
ADDRESS:12239 MOLINE DRIVETELEPHONE:
(562) 325-8418
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:4CENSUS: 4DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Administrator Nelson ArguellesTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
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5
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9
Facility did not ensure that staff dispensed medications to client as prescribed.
INVESTIGATION FINDINGS:
1
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3
4
5
6
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8
9
10
11
12
13
Licensing Program Analyst (LPAs) Kimberly Ramirez and Gabby Castro conducted an unannounced initial complaint investigation visit on 07/22/2025 to regarding the above allegation. During today’s visit, LPA Ramirez was greeted by Administrator Nelson Arguelles and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster (LIC 9020), Staff#1 (S1), copies of Client#1 (C1): physician’s order dated 5/01/25 & 6/3/25, medication administration record (MAR) dated June 2025, copies of Client#2 (C2): medication administration record (MAR) dated December 2024, Corrective Action Plan (CAP) dated 6/3/25, training material for Corrective Action Plan, and physical plant tour.

see 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20250717150019
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: JOURNEY TOGETHER MOLINE
FACILITY NUMBER: 198603709
VISIT DATE: 07/22/2025
NARRATIVE
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“Facility did not ensure that staff dispensed medications to client as prescribed.” It is alleged staff did not administer C1 their medication according to their physician’s orders on 06/01/25. On 7/22/25, LPA Ramirez conducted a review of C1’s medication administration record (MAR) dated June 2025 and physician’s order dated 5/01/25 & 6/3/25. Review of physician’s order dated 6/3/25, revealed on 5/28/25, C1’s physician ordered a medication change. Per C1’s new physician order, FLUOXETINE HCL 40 mg- 2 capsules by mouth daily changed to FLUOXETINE HCL 40 mg- 1 capsule by mouth daily. Review of C1’s medication administration record (MAR) dated June 2025, revealed staff administered C1’s medication according to their physician’s orders. The interview with Administrator Arguelles did not corroborate this 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.

No deficiencies were cited for this allegation. Exit interview was conducted. A copy of this report was provided via email.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5