197608604-3-6-2026-28-AS-RORN-DS3VBJ-20260311161737

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608604
Report Date: 03/06/2026
Date Signed: 03/06/2026 12:11:36 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
02/28/2026 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260228121123

FACILITY NAME:	PROMISE ASSISTED LIVING, LLC.		FACILITY NUMBER:	197608604
ADMINISTRATOR:	GREGORY Z. RESTUM		FACILITY TYPE:	740
ADDRESS:	1231 SOUTH ALVARADO STREET		TELEPHONE:	(310) 205-2591
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90006
CAPACITY:	22	CENSUS: 22	DATE:	03/06/2026
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Darolyn Azevedo – Assistant Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegations. LPA met with Assistant Administrator Darolyn Azevedo and explained the purpose of today's visit.

The investigation consisted of the following:

LPA obtained copies of Staff and Residnt Rosters, copies of pest control contract and most recent service date invoices, LPA toured facility, interviewed 4 Staff (S1-S4) and 5 Residents (R1-R5).

(Continued on LIC9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

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 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
02/28/2026 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260228121123

FACILITY NAME:	PROMISE ASSISTED LIVING, LLC.		FACILITY NUMBER:	197608604
ADMINISTRATOR:	GREGORY Z. RESTUM		FACILITY TYPE:	740
ADDRESS:	1231 SOUTH ALVARADO STREET		TELEPHONE:	(310) 205-2591
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90006
CAPACITY:	22	CENSUS: 22	DATE:	03/06/2026
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Darolyn Azevedo – Assistant Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Licensee did not ensure that facility is free of pests.
Facility is unsanitary.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

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

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 28-AS-20260228121123

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PROMISE ASSISTED LIVING, LLC.	FACILITY NUMBER: 197608604
	VISIT DATE: 03/06/2026

NARRATIVE

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The investigation revealed the following:
Allegation: Licensee did not ensure that facility is free of pests.
It is alleged that there were cockroaches observed at the facility. LPA toured facility, a total of 8 resident bedrooms, 4 restrooms, kitchen and dining area was toured and LPA did not observe any signs of roaches. Interviews with 4 staff denied the allegation, each stated they haven’t seen any roaches and confirmed that there is a pest control treatment done weekly. LPA interviewed 5 residents and each stated they haven’t seen any roaches but do notice the facility being sprayed/fumigated often. LPA obtained copies of pest control contract and most recent visits, contract was created 7/21/21 and indicated that both interior and exterior perimeter, common areas, planters, trash and all entry points would be treated monthly, upon reviewing the invoices, it appears that this service is now weekly with most recent visits dated 3/4/26, 2/18/26, 2/4/26, 1/28/26, 1/21/26,1/14/26, 1/7/26, there were no indications of roach activity on these invoices, only the routine treatments.

Allegation: Facility is unsanitary.

It is alleged that there is grease and food debris on the countertops and there is accumulation of trash in the bathrooms. LPA toured facility, kitchen was inspected, staff were cleaning the kitchen, there were no signs of grease or food debris on the countertops, there is a door that blocks access to the kitchen and staff stated residents do not enter the kitchen area. LPA inspected client room and bathrooms there was no observations of accumulated trash. LPA interviewed 4 staff and each denied the allegation and stated that the trash is taken out at least two times daily. LPA interviewed 5 residents and each denied the allegation, residents each stated their trash is taken out twice daily and have never seen accumulation of trash in the bathrooms.

Based on statements and interviews conducted with staff/residents, review of facility file records, and LPA's observations, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260228121123

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PROMISE ASSISTED LIVING, LLC.	FACILITY NUMBER: 197608604
	VISIT DATE: 03/06/2026

NARRATIVE

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The investigation revealed the following:

Allegation: Facility is in disrepair.

It is alleged that there are multiple window screens missing and laundry room window is in disrepair. LPA toured facility and observe window screens missing in dining area, the following resident bedrooms were missing window screens: room #’s 8, 9/10, and 17/18. Interview with S1 confirmed that they are repairing window screens as there was a visit by the housing department where this was mentioned, S1 took immediate action and is currently making all the necessary repairs.

Based on LPAs observations and interviews which were conducted , the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC9099D. Exit interview held, and a copy of this report and appeal rights were provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 28-AS-20260228121123

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PROMISE ASSISTED LIVING, LLC.	FACILITY NUMBER: 197608604
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/20/2026 Section Cited CCR 87303(c)	1 2 3 4 5 6 7	87303 Maintenance and Operation (c) All window screens shall be clean and maintained in good repair. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Licensee/Administrator to ensure all windows have window screens and add window screens to the areas mentioned in report. Photos of the windows with screens shall be emailed to LPA by POC due date. tena.herrera@dss.ca.gov
	8 9 10 11 12 13 14	During tour LPA observed multiple window screens missing throughout the facility, specifially in dining room and the following resident bedrooms: room #’s 8, 9/10, and 17/18.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

LIC9099 (FAS) - (06/04)

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