197608232-9-10-2025-11-AS-SCIS-DLV2FR-20250925172157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608232
Report Date: 09/10/2025
Date Signed: 09/10/2025 01:23:54 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2025 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 11-AS-20250902124215

FACILITY NAME:	SUMMER HOUSE AT LADERA HEIGHTS		FACILITY NUMBER:	197608232
ADMINISTRATOR:	SHERRYL RAFOLS		FACILITY TYPE:	740
ADDRESS:	6108 DAMASK AVENUE		TELEPHONE:	(323) 792-4105
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90056
CAPACITY:	4	CENSUS: 3	DATE:	09/10/2025
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Marilyn Nery- Support Staff		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Licensee is restricting resident's vistations.

INVESTIGATION FINDINGS:

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On 09/10/2025 At 8:15 AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct a complaint investigation and deliver the findings for the alleged allegation. LPA Allen was met by Marilyn Nery-Support Staff. LPA Allen introduced herself and explained the purpose of the visit and was allowed entry into the facility.

The investigation consisted of the following:

At 8:30 AM LPA Allen requested and obtained copies of the following documents: Admission Agreement, Needs/Service plan, ID/Emergency Information, Physicians Report, and Pre-placement Appraisal Information for Resident 1 (R1), visitor sign in sheet from 7/3/2025-9/10/2025 and reviewed the Staff/Client Roster which needs to be updated as of 9/10/2025. Eden Hospice Care Inc. Notice of hospice patient dated 8/26/2025. LPA interviewed Staff 1-2 (S1-S2), attempted to interview Resident 1-2 (R1-R2), LPA interviewed Resident 3-4 (R3-R4), and Witness 1 (W1).
Continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250902124215

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SUMMER HOUSE AT LADERA HEIGHTS	FACILITY NUMBER: 197608232
	VISIT DATE: 09/10/2025

NARRATIVE

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Investigation revealed the following:

Allegation: Licensee is restricting resident's visitations.

On 9/10/2025, LPA interviewed Staff 1 and Staff 2 (S1 - S2). Both staff members confirmed that Resident 1 (R1) was allowed to have visitors on 8/30/2025 and 9/2/2025.

S1 stated that on both 8/30/2025 and 9/2/2025, there was a delay in responding to the front door due to assisting another resident. S1 further stated that on 8/30/2025, the visitor waited approximately 15 minutes before being verbally informed of R1’s bedroom location, where the visit subsequently took place.

S2 stated that a call was made to them regarding the visitor; however, the visitor had already been allowed entry into the home prior to the call and was permitted to visit R1.

Both S1 and S2 confirmed that R1 was also allowed to have visitors on 9/2/2025. The interviews revealed that although there was a delay in answering the door, R1 was not restricted from having visitors.

LPA reviewed the facility’s sign-in sheet and found no documentation indicating that R1 had visitors. However, staff interviews confirmed that R1 was allowed visitors and that entry into the facility was granted.

At 10:25 AM, LPA attempted to interview Residents 1 and 2 (R1 - R2). However, R1 had recently passed away, and R2 was unavailable due to an appointment.

Residents 3 and 4 (R3 - R4) both stated they have never been denied or restricted from having visitors.

Interview with Witness 1 (W1) confirmed that R1 was able to have visitors on both 8/30/2025 and 9/2/2025.

Based on the evidence gathered during the investigation, the above allegation is found to be Unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, during which this report was discussed and provided to Marilyn Nery at the conclusion of the visit, along with appeal rights.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2025

LIC9099 (FAS) - (06/04)

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