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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608374
Report Date: 10/22/2025
Date Signed: 12/19/2025 11:24:37 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/10/2025 and conducted by Evaluator Pamela Bunker
COMPLAINT CONTROL NUMBER: 11-AS-20250910171345
FACILITY NAME:IN HONOR OF OUR PARENTS, INC.FACILITY NUMBER:
197608374
ADMINISTRATOR:ANGELA LOVEFACILITY TYPE:
740
ADDRESS:1317 W. 40TH PLACETELEPHONE:
(323) 296-7816
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY:6CENSUS: 6DATE:
10/22/2025
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Angela LoveTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff accepted a resident with a prohibited health condition.
INVESTIGATION FINDINGS:
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On October 22, 2025, at 12:25 p.m., Licensing Program Analyst (LPA) Pamela Bunker conducted an initial visit to gather information regarding the above allegation. LPA met with Licensee Angela Love and explained the purpose of the visit. LPA was granted entry into the facility.

The investigation consisted of the following: On 10/22/2025, the following documents were reviewed and obtained as part of the investigation: Personnel Report (dated 09/16/2025), Resident Roster (dated 10/21/2025), Admission Agreement (dated 06/13/2025), Identification and Emergency Information (dated 06/13/2025), Physician’s Report (dated 06/13/2025), Medical Assessment (dated 0613/2025), Medication Administration Records (MARs) (06/13/2025 - present), Appraisal & Needs and Services Plan (dated 06/13/2025), Resident Appraisal Residential Care Facilities for the Elderly (06/13/2025), Functional Capability Assessment (dated 06/13/2025), Preplacement Appraisal Information (dated 06/13/2025), House Rules (dated 06/13/2025), Personal Rights (dated 06/13/2025), Consent Forms (dated 06/13/2025),
See continued LIC9099-C – Page 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
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 11-AS-20250910171345
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: IN HONOR OF OUR PARENTS, INC.
FACILITY NUMBER: 197608374
VISIT DATE: 10/22/2025
NARRATIVE
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Continued LIC9099-C – Page 2

Hospice enrollment packet (dated 06/13/2025), and Advance Health Care Directive (dated 08/11/2025).

On 09/16/2025 and 10/22/2025, LPA Bunker toured the facility's buildings and grounds to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. No signs of neglect or abuse were observed during today's visit.

On 10/22/2025, between 1:00 p.m. and 4:30 p.m., LPA Pamela Bunker conducted interviews with staff members #1–#4 (S1–S4) regarding the complaint allegation.

On 10/22/2025, from 12:30 p.m. to 1:00 p.m., LPA Bunker attempted to interview residents #1–#3 (R1–R3). R1-R2 are non-verbal and unable to participate in the interview process, and R3 failed to answer any of the questions posed, follow the conversation, or demonstrate understanding of the inquiries.



Investigation revealed the following.
Allegation: Staff accepted a resident with a prohibited health condition.
On 10/22/2025, between 1:00 p.m. and 4:30 p.m., the Department conducted interviews with staff members #1-#4 (S1-S4). Who stated that the facility did not accept a resident with a prohibited health condition. 4 out of 4 staff confirmed that Resident #1 (R1) was admitted to the facility with a stage lV wound and is currently on hospice care, receiving ongoing treatment for the condition. 4 out of 4 staff stated that the hospice team provides regular services to R1. A home health nurse visits once a week, a bath nurse visits twice a week, and the wound care physician visits once a week. 4 out of 4 staff reported that R1 no longer has a gastrostomy tube. The Stage IV wound is actively being treated by R1’s wound care physician using stem cell therapy. 4 out of 4 staff members confirmed that the facility holds an approved hospice waiver, authorizing the provision of hospice services within the facility. 4 out of 4 staff members denied the allegation.

On 10/22/2025, from 12:30 p.m. to 1:00 p.m.., the Department attempt to interviewed three residents #1-#2 (R1-R2). 2 out of 2 residents was non-verbal, and 1 out of 3 had difficulties understanding and answering the questions.

See continued LIC9099-C – Page 2

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250910171345
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: IN HONOR OF OUR PARENTS, INC.
FACILITY NUMBER: 197608374
VISIT DATE: 10/22/2025
NARRATIVE
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Continued LIC9099-C Page 3.

The Department reviewed Resident #1’s (R1) Physician’s Report and Hospice Records dated June 13, 2025, through the present. R1 was admitted to the facility on June 13, 2025, in accordance with the signed Admission Agreement. The Physician’s Report, completed on the date of admission, documented that R1 presented with a Stage IV wound upon entry. Hospice records, also dated June 13, 2025, confirm that R1 was under the care of Appling Hospice at the time of admission and has been receiving wound treatments and in-home health services since that time.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated.

There were no deficiencies cited.

A copy of the Complaint Investigation Report LIC9099 and LIC9099-Cs was provided to Angela Love, Licensee.

An exit interview was conducted
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3