198603727-11-4-2025-28-AS-WSHO-DNKQ3F-20251119104841

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603727
Report Date: 11/04/2025
Date Signed: 11/04/2025 01:33:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/03/2025 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251103093435

FACILITY NAME:	NORWALK VILLAS I		FACILITY NUMBER:	198603727
ADMINISTRATOR:	WOOD, CHERIE		FACILITY TYPE:	740
ADDRESS:	12121 164TH ST		TELEPHONE:	(562) 229-9957
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	6	CENSUS: 4	DATE:	11/04/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Cherie Wood		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff inappropriately touched resident
Staff are not following doctor's orders for resident
Staff are not providing adequate food service to resident
Staff make resident feel uncomfortable
Staff are not providing a safe environment for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Staff S1. Administrator Cherie Wood arrived shortly after and the reason for the visit was explained.

The investigation consisted of the following: LPA Trueman obtained copies of the Staff roster, Resident Roster, and Special Incident Report (SIR).
Resident R1's file was reviewed copies of Physician's Report, MAR's Log, Physician's Order, Centrally Stored Medication Log and Emergency ID Face Sheet to be submitted.
Tour of the facility was conducted which included the kitchen and observation of the food supply
Interviews were conducted with Administrator, Staff S1 and Staff S2. Resident R1- R4 was interviewed.
Social Worker for Resident R1 was interviewed. Medication was reviewed for Resident R1.
In regards to the allegation Staff inappropriately touched resident, based on interviews conducted and information gathered, Resident R1 who stated that he doesn't know if the touch was appropriate or

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025

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 3

Control Number 28-AS-20251103093435

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: NORWALK VILLAS I	FACILITY NUMBER: 198603727
	VISIT DATE: 11/04/2025

NARRATIVE

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inappropriate.
Social Worker for Resident R1 stated that she does not think there is any evil intent to touching having occurred.
Stated that staff are very nice and there have been no issues at all.
Resident's R2-R4 stated that staff has never touched them inappropriately and never seen them touch R1 inappropriately.
Said they have had blood pressure checked and it has always been appropriate.
All said staff are great and the house is peaceful till R1 arrived.
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 allegations are Unsubstantiated.

In regards to the allegation Staff are not following doctor's orders for resident, based on interviews conducted and information gathered Resident R1 revealed that the doctor prescribed new meds and he never heard the doctor say don't take meds.

Resident's R2-R4 stated they always have received their medication and staff has always done a good job. Said they heard R1 stating he doesn't want to take medication because of the side affects. Staff S1, S2 and the Administrator stated that R1 has been receiving medication daily and they initial each day on the MAR's Log. Review of medication for R1 for November show all doses administered as prescribed. Physician's Order dated 10/25/25 was observed by the LPA which included 4 medications.

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 allegations are Unsubstantiated.

In regards to the allegation Staff are not providing adequate food service to resident based on interviews conducted and information gathered Resident R1 stated that the hair could have been from his blanket or cap. Said not sure. Social Worker for Resident R1 stated that not sure about the hair, but it is consistent with R1's behavior. R3 stated to be here 1 and 1/2 years and never has there been a hair in their food. Said they all wear hair nets and it easily could have been R1's hair. R2 and R4 also stated staff always wear hair nets and they have never had hair in their food. Administrator and Staff S1-S2 stated they always wear hair nets

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 allegations are Unsubstantiated.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20251103093435

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: NORWALK VILLAS I	FACILITY NUMBER: 198603727
	VISIT DATE: 11/04/2025

NARRATIVE

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In regards to the allegation Staff make resident feel uncomfortable, based on interviews conducted and information gathered Social Worker for Resident R1 stated that there has been no issues with this facility.
Stated staff are nice and residents are not aggressive.
Said there have been no visits from outside agencies until now.
Stated that there are other residents that are in the home and they have always said the home is very peaceful, comfortable and like a family.
Spoke with Administrator, Staff S1 and S2 who all stated the residents are always taken care of. It is always peaceful and they are like a family. Said they are nice to R1 and assist like they do for all with medication and food. Always try to make residents comfortable.
Resident R2-R4 said staff always have made them feel comfortable and said they have done the same treatment for R1.

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 allegations are Unsubstantiated.

In regards to the allegation Staff are not providing a safe environment for resident, based on interviews conducted and information gathered Resident's R2- R4 all stated that R1 was the one who tried to attack staff and also them. All said it is R1 who has made the place unsafe. All stated that Staff S1 came to check on residents outside and then R1 chased staff in.
R3 stated he went to stick up for Staff S1 and R1was then yelling and screaming.
Social Worker for R1 stated the staff and residents are very nice and there has been no issues until now.
Administrator stated it is a very safe environment and there are no aggressive residents. Said it is not unsafe and can freely walk all over.
Staff S1 and S2 stated that it is very safe and all have been here a long time. If residents are outside the house they will check on their safety.
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 allegations are Unsubstantiated.

Exit interview conducted and report provided to Administrator.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025

LIC9099 (FAS) - (06/04)

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