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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197803745
Report Date: 12/01/2025
Date Signed: 12/01/2025 11:35:02 AM

Unsubstantiated


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
11/20/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251120162523
FACILITY NAME:COUNTRY INN OF DOWNEYFACILITY NUMBER:
197803745
ADMINISTRATOR:ANA YESENIA GIRONFACILITY TYPE:
740
ADDRESS:11111 MYRTLE ST.TELEPHONE:
(562) 869-2401
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:150CENSUS: 86DATE:
12/01/2025
UNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Erika BecerraTIME COMPLETED:
11:35 AM
ALLEGATION(S):
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Unlawful eviction.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with MedTech/Assistant Administrator Erika Becerra and explained the purpose of today's visit.

The investigation consisted of the following:
On 11/25/25 LPA obtained copies of staff & resident rosters, copy of House Rules signed by Resident #1 (R1), and conducted interviews with 3 Staff (S1-S3) and 9 Residents (R1-R9).
During todays visit 12/1/25 LPA delivered findings on the above allegations.

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
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 2
Control Number 28-AS-20251120162523
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: COUNTRY INN OF DOWNEY
FACILITY NUMBER: 197803745
VISIT DATE: 12/01/2025
NARRATIVE
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The Investigation revealed the following:

Allegation: Unlawful eviction.
It is alleged that the Administrator is evicting R1 from facility, R1 is unsure why and has not been provided with a written eviction notice. LPA interviewed R1 and resident stated they did not hear this information from the administrator directly but their social worker has mentioned to them that their housing at the facility is in jeopardy if they continue to drink alcohol. LPA interviewed Administrator and 2 other Staff and each denied the allegation. Interview with administrator revealed that staff have not formally provided an eviction notice to R1 and that R1 was warned by a social worker that works for the agency that provides support and placement for R1 that if R1 continues to drink they will risk losing their housing at the facility. LPA obtained a copy of the House Rules signed by R1 on 8/4/2025 that states under #5 that residents who are non-compliant with the use of alcohol and their doctors orders, or who demonstrate inappropriate behavior in conjunction with the use of alcohol will be considered inappropriate to continue living at facility. LPA interviewed a total on 9 residents and 8 out of 9 residents denied the allegation and stated they have never been threatened to be evicted nor have they ever been issued an eviction notice.

Based on statements and interviews conducted with staff/residents and review of R1's file, there was not enough supportive evidence to concur with the reported 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 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: 12/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2