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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607320
Report Date: 11/06/2025
Date Signed: 11/06/2025 12:24:54 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
07/23/2025 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250723191517
FACILITY NAME:CERRITOS VILLA 1FACILITY NUMBER:
197607320
ADMINISTRATOR:JULIO NAVALLOFACILITY TYPE:
740
ADDRESS:16231 DRYCREEK LANETELEPHONE:
(562) 404-0767
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:6CENSUS: 4DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Julio NavalloTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff admitted a resident with a prohibited health condition
Staff mishandled a resident's medication
Staff did not ensure a resident was properly fed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent complaint visit regarding the allegations listed above. LPA arrived unannounced and met with Staff S1. The purpose of the visit was explained. Administrator, Julio Navallo, arrived shortly after.

The initial visit was conducted on 07/29/25 and included the following:
LPA reviewed Resident R1's file and the facility to submit resident roster, staff roster, and documents pertaining to Resident (R1). LPA toured the facility and interviewed the assistant administrator telephonically.
Resident R2 was interviewed at today's visit.
Attempts were made to interview Resident R3 were unsuccessful with R3 unable to respond to questioning
Resident R1 was in the hospital as of 7/28/25.
At today's visit 11/06/25 Resident R2 and R3 were interviewed. Attempts were made to interview Resident R4 and R5 were unsuccessful with both residents unable to respond to questioning.

.



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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 4
Control Number 28-AS-20250723191517
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: CERRITOS VILLA 1
FACILITY NUMBER: 197607320
VISIT DATE: 11/06/2025
NARRATIVE
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It should be noted that Resident R1 passed away on 08/05/25.
Hospice chart was reviewed in regards to Resident R1.
Staff S1-S3 were interviewed.
In regards to the allegation Staff admitted a resident with a prohibited health condition, based on interviews conducted and information gathered it was revealed by family member of Resident R1 that there was never wrong doing by the facility and they did a good job providing care. Stated the complaint is with the Hospice agency.
R1 was admitted to the facility on 7/9/23 with hospice services for the gastrostomy (G) tube.
Per the administrator and facility staff, R1 is provided food and medications through the G tube. Interview with Assistant Administrator who stated that staff are trained on how to assist the resident on the g-tube. They only give the formula via g-tube (about 5 cartons a day) and then flush it after the feeding to clean the tube. The staff do not replace the dressing. Stated that hospice nurse trained them on what to do and gave instructions to the staff in the beginning. (LPA observed Staff Training Certificates in regards to G-Tube Training). Administrator stated they have a Hospice Care Plan regarding Resident R1. Stated that Hospice supervised staff regarding the G-Tube. If any emergency issues Hospice is called immediately. Staff S1-S3 stated that they all had training regarding G-Tube Care. Said the G-Tube for Resident R1 would clog and as instructed they would try to flush it with water and if still clogged they call Hospice immediately. Hospice Visit Notes state on 10/29/24 G-Tube cleared and changed with new dressing. On 11/02/24 G-Tube clogged. 11/04/24- Medical doctor aware of G-Tube replacement. 11/26/24 g-tube not working. Can not aspirate or flush. Will follow up. On 12/03/24 G Tube dressing changed. G Tube clogged. Follow Up on G-Tube replacement. Interviews with Resident's R2 and R3 both stated staff treat them well and they are getting great care and staff will assist them with whatever they may need assistance with.

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.


SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20250723191517
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: CERRITOS VILLA 1
FACILITY NUMBER: 197607320
VISIT DATE: 11/06/2025
NARRATIVE
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In regards to the allegation Staff mishandled a resident's medication, based on interviews conducted and information gathered it was revealed by the family member of Resident R1 that staff did a good job taking care of R1. Said he was satisfied with R1 being fed and given medications. Stated his issue is with Hospice Agency and not the facility.
Staff S1- S3 stated that staff will give meds through the tube. When it gets clogged, they were instructed to put some warm water on syringe and then flush it. If the tube has been clogging the hospice nurse is made aware of it and will assist Resident R1.
Administrator stated that staff all had in-service G-Tube training. Hospice supervised staff on feeding and medication administered. If emergency will call Hospice immediately.
Assistant Administrator stated that Resident R1's family member had talked to her about filing a complaint on the hospice agency. Also stated that the staff are trained on how to assist the resident on the g-tube. They only give the formula via g-tube (about 5 cartons a day) and then flush it after the feeding to clean the tube. The staff do not replace the dressing. Stated that the Hospice nurse taught them what to do and gave instructions to the staff in the beginning.
Hospice Visit Notes state on 10/29/24 G-Tube cleared and changed with new dressing. On 11/02/24 G-Tube clogged. 11/04/24- Medical doctor aware of G-Tube replacement. 11/26/24 G-tube not working. Can not aspirate or flush. Will follow up. On 12/03/24 G Tube dressing changed. G Tube clogged. Follow Up on G-Tube replacement. Interviews with Resident's R2 and R3 both stated staff treat them well and they are getting great care and staff will assist them with whatever they may need assistance with including medication and meals.

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.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20250723191517
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: CERRITOS VILLA 1
FACILITY NUMBER: 197607320
VISIT DATE: 11/06/2025
NARRATIVE
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In regards to the allegation Staff did not ensure a resident was properly fed, based on interviews conducted and information gathered it was revealed by family member of Resident R1 that there was never wrong doing by the facility and they did a good job providing care. Stated the complaint is with the Hospice agency.
Also stated that he was here often at the facility and Resident R1 was always fed and administered medication properly.
Administrator stated that they follow the care plan for Resident R1 since using a G-tube. Staff do not change the dressing. They are instructed to notify the hospice agency if the dressing is soiled or has a smell. They are only feeding the formula through the G-tube and flushing/cleaning it right after.
Assistant Administrator stated that staff are trained on how to assist the resident on the G-tube. They only give the formula via G-tube (about 5 cartons a day) and then flush it after the feeding to clean the tube. The staff do not replace the dressing. Stated that the Hospice nurse trained them on feeding.
Staff S1-S3 stated they check Resident R1's G- tube every time to see if it is ok. The hospice nurse had instructed staff what to do and how to properly clean the tube. Stated they put the milk in the bag and when the feeding is done, they add water to flush it out and remove the tube for cleaning.
Hospice Visit Notes state on 10/29/24 G-Tube cleared and changed with new dressing. On 11/02/24 G-Tube clogged. 11/04/24- Medical doctor aware of G-Tube replacement. 11/26/24 G-tube not working. Can not aspirate or flush. Will follow up. On 12/03/24 G Tube dressing changed. G Tube clogged. Follow Up on G-Tube replacement.

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.



SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4