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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197803745
Report Date: 04/12/2026
Date Signed: 04/12/2026 11:33:05 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
03/25/2026 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260325113402
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: 89DATE:
04/12/2026
UNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Tania Janeta - MedTechTIME COMPLETED:
11:42 AM
ALLEGATION(S):
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Staff do not ensure that residents' dietary needs are met.
Staff do not maintain facility clean.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint visit to deliver findings on the reported allegations. LPA met with Tania Janeta and explained the purpose of today's visit.

The investigation consisted of the following:

On 4/2/26 LPA conducted initial visit and obtained copies of staff/resident rosters, conducted interviews with 2 Staff (S1-S2) and 8 Residents (R2-R9) toured facility including patios and designated smoking areas.
On 4/8/26 LPA interviewed 1 Resident (R1) and 4 Staff (S3-S6) via phone calls.
During today’s visit LPA delivered findings on the reported allegations.

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

DATE: 04/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2026
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 2
Control Number 28-AS-20260325113402
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: 04/12/2026
NARRATIVE
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The Investigation revealed the following:
Allegation: Staff do not ensure that residents' dietary needs are met.
It is alleged that the residents at the facility are not being provided with filling or nutritious meals. LPA toured kitchen and dining area and observed sufficient supply of perishable and non-perishable foods. LPA observed meal being served during dinner hour on 4/2/26 and it was same as what was listed on the weekly menu that was provided to LPA, breaded chicken, potatoes and vegetables, plates being served appeared to be of a good amount/portion of food. LPA interviewed 9 residents and 7 out of 9 residents denied the allegation and stated that the food amount is fine, they feel they are provided with enough food and second servings are provided if asked. LPA interviewed 6 staff and each denied the allegation, S1 and S4 explained that there are 2 rounds for meal times and the first round may be limited as these residents are on monitored diets or diabetic diets, however, if the resident is persistent even after they are reminded of the dietary restrictions an extra plate will be provided.

Allegation: Staff do not maintain facility clean.


It is alleged that the patio at the facility is filthy with cigarette butts everywhere. LPA toured facility, the front patio appeared clean with very few cigarette butts observed (no more than 6), the back patio area that is designated for smoking did appear to have more cigarette butts on the ground, there were around 8-10 residents smoking in the area, LPA observed 4 of these residents throwing their cigarette butts in a tree planter and on the floor, prior to leaving the facility LPA observed a maintenance staff sweeping the area. LPA interviewed 6 staff and each denied the allegation and stated that although the area may get a bit dirty throughout the day there is a maintenance staff and housekeepers that will sweep and try to maintain the area as clean as possible, staff mentioned that a majority of the residents are smokers and will throw the cigarette buts on the ground rather than the ash tray or trash cans that are placed in the area for their convenience. LPA interviewed 9 residents and each stated they notice that the patio does get messy with cigarette butts, however, staff are seen cleaning the area in the morning and throughout the day.

Based on statements and interviews conducted with staff/residents 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: 04/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2026
LIC9099 (FAS) - (06/04)
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