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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004004
Report Date: 11/04/2025
Date Signed: 11/04/2025 02:00:51 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
11/04/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251104045557
FACILITY NAME:WHITTIER RESIDENTIAL HOMESFACILITY NUMBER:
306004004
ADMINISTRATOR:GERARDO ZAMORA JR.FACILITY TYPE:
735
ADDRESS:9633 GUNN AVENUETELEPHONE:
(562) 698-1862
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY:6CENSUS: 6DATE:
11/04/2025
UNANNOUNCEDTIME BEGAN:
11:41 AM
MET WITH:Administrator Gerardo Zamora JrTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not administer medication to a resident in care.
Staff did not properly manage residents P&I funds.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 11/04/2025 regarding the above allegations. During today’s visit, LPA Ramirez was greeted by Caregiver- Mirna Hernandez and explained the purpose of the visit. Administrator Gerardo Zamora Jr arrived shortly after to assist.
The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster (LIC 9020), Staff Roster (LIC 500), Staff#1 interview (S1), Attempted interview of Staff#2 (S2), Attempted interview of Clients#1-6 (C1-C6), requested and obtained copies of C1-C6: Record of Client’s/Resident’s Safeguarded Cash Resources, copy of Medication Administration Record for C1, copy of C1’s physician’s orders for October 2025, copy of Vendor Special Incident Report for C1 dated 10/08/2025, Disbursement and Safeguarding of P&I training and Medication Training, Eastern Los Angeles Regional Center Corrective Action Plan (CAP) dated 10/30/2025, and physical plant tour.
SEE 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
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-20251104045557
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: WHITTIER RESIDENTIAL HOMES
FACILITY NUMBER: 306004004
VISIT DATE: 11/04/2025
NARRATIVE
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The investigation revealed the following: regarding the allegation “Staff did not administer medication to a resident in care.” It is alleged on 10/07/2025, C1 was not administered their medication. One (1) out of one (1) staff interviewed corroborated this allegation. Review of Eastern Los Angeles Regional Center Corrective Action Plan (CAP) dated 10/30/205 and Vendor Special Incident Report for C1 dated 10/08/2025 corroborated this allegation. Review of Vendor Special Incident Report for C1 dated 10/08/2025, revealed on 10/07/2025 during the PM medication pass, S2 did not administer C1’s scheduled PM medication of Benztropine MES 1mg tablet and Lisinopril 5mg. On 10/08/2025, Eastern Los Angeles Regional Center staff was conducting a Quality Assurance inspection and discovered these medications were still in C1’s medication bubble pack even though S1 indicated on the MAR that these medications were administered to C1 the night prior. Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

“Staff did not properly manage residents P&I funds.” It is alleged staff did not properly manage Personal and Incidental (P&I) funds for C1, C3, C4 and C5. One (1) out of one (1) staff interviewed corroborated this allegation. Review of Eastern Los Angeles Regional Center Corrective Action Plan (CAP) dated 10/30/205 and Vendor Special Incident Report for C1 dated 10/08/2025 corroborated this allegation. Review of C1, C3, C4 and C5’s Record of Client’s/Resident’s Safeguarded Cash Resources corroborated this allegation. Interview with S1 revealed that in October and September of 2025, S2 took the clients out into the community to purchase items at local retail store. S2 did not ensure clients purchased their own items individually, obtain a receipt for each client’s purchase and commingled the clients’ monies to complete one group purchase. S1 revealed S2 did not follow facility staffing procedure on disbursement and safeguarding of clients P&I monies. On 10/08/2025, Eastern Los Angeles Regional Center staff were conducting a Quality Assurance inspection and discovered money shortages for C1, C3, C4 and C5’s Record of Client’s/Resident’s Safeguarded Cash Resources. C1 was owed $22.21 for a purchase made on 09/23/25, C3 was owed $32.91 for purchase made on 09/01/25 and $22.21 for a purchase made on 09/23/25, C4 was owed $22.21 for a purchase made on 09/23/25, C5 was owed $22.21 for a purchase made on 09/23/25 and C6 was owed $22.21 for a purchase made on 09/23/35. 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) type A deficiency is being cited for this complaint investigation. A copy of this report, 9099-D and appeals rights was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
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)
Page: 2 of 3
Control Number 28-AS-20251104045557
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: WHITTIER RESIDENTIAL HOMES
FACILITY NUMBER: 306004004
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2025
Section Cited
CCR
80065(a)
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(a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement was not met as evidenced by: S2 did not administer C1 their medication on 10/7/25 and S2 did not
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Administrator conducted staff re-training on Medication Administration and disbursement and safeguarding of clients P&I on 10/9/25. This clears 24hour correction. No futher action required.
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follow facility staffing procedure on disbursement and safeguarding of clients P&I monies on 09/23/25 & 09/01/25. 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.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3