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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606651
Report Date: 09/23/2025
Date Signed: 09/23/2025 02:31:23 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
09/15/2025 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250915201751
FACILITY NAME:LAKEWOOD GARDENSFACILITY NUMBER:
197606651
ADMINISTRATOR:MARIE JEENE R DE CASTROFACILITY TYPE:
740
ADDRESS:12055 S. LAKEWOOD BLVD.TELEPHONE:
(562) 869-4038
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:150CENSUS: 82DATE:
09/23/2025
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Jeenne De Castro AdministratorTIME COMPLETED:
02:46 PM
ALLEGATION(S):
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Staff did not dispense medications as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced complain visit on 09/23/2025, in regard to the allegations listed above. LPA met with Administrator Jeenne De Castro and explained the purpose of the visit.

The investigation consisted of the following: LPA did a random medication check on four residents, interviewed Administrator, staff 1- 4, attempted to interview residents R1-R6 and interviewed R1’s family. LPA obtained copies of the following documents: staff roster, resident roster, R1’s physicians reports, identification information , appraisal needs and service plan, hospital discharge paperwork, medication list, and facility notes. During today’s visit LPA delivered findings.

See 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
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-20250915201751
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: LAKEWOOD GARDENS
FACILITY NUMBER: 197606651
VISIT DATE: 09/23/2025
NARRATIVE
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In regard to the allegation” Staff did not dispense medications as prescribed”, It is alleged that staff administered wrong medication to R1 resulting in a positive urine test of an opioid causing R1 to be hospitalized. During interview with Administrator, and staff three (3) out of five (5) stated that to their knowledge no medication error has occurred. Two staff stated that they do not give out medication. During interviews it was revealed that R1 took Morning medication at 8:00 AM given by med-tech and that by 9:20 AM R1 appeared weak and was slurring. S3 stated that in the early morning R1 was awake and given breakfast with no problems. S4 stated the night before R1 was taken to hospital there were no signs of any problems during his/her shift. LPA attempted to interview six (6) residents but due to their cognitive condition LPA was unable to interview them. LPA interviewed R1’s family and it was revealed that R1 only takes two medications omeprazole in the morning, and Zoloft (sertraline) which him/her dispenses in the afternoon and when tested at hospital Tricyclic was found in urine.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted, and a copy of this report was given to Administrator.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250915201751
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: LAKEWOOD GARDENS
FACILITY NUMBER: 197606651
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied: Appeal Not Submitted Timely
Type A
09/24/2025
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

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Administrator will conduct medication training to med-techs and send to LPA by POC due date.
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Based on interviews conducted and documents review R1 received wrong medication which poses an immediate risk to the health, safety, or personal rights to the 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: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3