198204972-4-4-2025-11-AS-UCOL-DGNNKS-20250514103224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204972
Report Date: 04/04/2025
Date Signed: 04/04/2025 05:04:55 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, 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
04/03/2025 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20250403095344

FACILITY NAME:	ROSECRANS VILLA RESIDENTIAL CARE		FACILITY NUMBER:	198204972
ADMINISTRATOR:	SANDRA LOPEZ		FACILITY TYPE:	740
ADDRESS:	14110 CORDARY AVENUE		TELEPHONE:	(310) 675-9163
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY:	135	CENSUS: 112	DATE:	04/04/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Adminstrator - Sandra Lopez		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Licensee does not ensure food served is of good quality
Staff did not seek medical attention for resident in a timely manner

INVESTIGATION FINDINGS:

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On 04/04/2025, the California Department of Social Services (CDSS) Community Care Community Care Licensing (CCL) Licensing Program Analyst (LPA) Socorro Leandro conducted an initial unannounced complaint visit. LPA met with Administrator, Sandra Lopez and the purpose of the visit was explained. LPA was granted entry to the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025

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 4

Control Number 11-AS-20250403095344

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: ROSECRANS VILLA RESIDENTIAL CARE	FACILITY NUMBER: 198204972
	VISIT DATE: 04/04/2025

NARRATIVE

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The investigation consisted of the following:

On 04/04/2025, a facility tour was conducted, records were reviewed, and interviews were conducted. The facility tour consisted of the kitchen area. Interviews consisted of 5 staff interviews [Staff 1 (S1) to Staff 5 (S5) were interviewed] and 11 resident interviews [Resident 2 (R2) to Resident 12 (R12) were interviewed]. Facility records reviewed consisted of Personnel Report dated 01/2025, Register of Facility Residents dated 01/01/2025, Weekly Menu for Week 1 to Week 4, Dietary Consultant Reports from 01/18/2025, 02/16/2025, and 03/23/2025. Resident 1 (R1) records reviewed consisted of Admission Agreement dated 01/01/2024, Physicians Report dated 11/18/2023, Appraisal & Needs Services Plan dated 06/19/2024, Refusal of Medical Attention and/or Hospitalization documents, Medical Records, etc.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20250403095344

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: ROSECRANS VILLA RESIDENTIAL CARE	FACILITY NUMBER: 198204972
	VISIT DATE: 04/04/2025

NARRATIVE

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The investigation revealed the following:

Allegation: “Licensee does not ensure food served is of good quality”, it is being alleged that the facility food has poison and that is why it taste bad. Interviews conducted with S1 to S5 revealed the following: 5 out 5 staff denied the allegation. Interviews conducted with R2 to R12 revealed the following: 11 out of 11 residents denied the allegation. Observations of the kitchen on 04/04/2025 revealed the following: the department did not observe poisons in the kitchen area and observed food to be of good quality. Based on interviews and observations this allegation is unsubstantiated. Records reviewed revealed the following: Dietary Consultant Reports from 01/18/2025, 02/16/2025, and 03/23/2025 do not mention poison, moreover, on the latest report dated 03/23/2025 it indicates that food is of good quality. The Weekly Menu for Week 1 to Week 4 depicts breakfast, lunch, and dinner as being well balanced meals. Based on the interviews, records, and observations this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20250403095344

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: ROSECRANS VILLA RESIDENTIAL CARE	FACILITY NUMBER: 198204972
	VISIT DATE: 04/04/2025

NARRATIVE

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Allegation: “Staff did not seek medical attention for resident in a timely manner”, it is being alleged that staff did not seek timely medical attention for R1. Interviews conducted with the Administrator (S1) revealed the following: According to the Administrator the facility had attempted to seek medical attention for R1 but R1 refused to accept medical care. R1s records reviewed revealed the following: R1 had her physical on 11/18/2023. R1 refused medical attention on 01/24/2024. R1 had laboratory work done on 06/05/2024. R1 was placed in a 51/50 hold on 06/21/2024 to 06/28/2024 for signs of decompensation. R1 refused medical attention on 07/23/2024, 09/05/2024, and 03/10/2025. On 03/10/2025, the facility called the Los Angeles Country Department of Mental Health, and the Psychiatric Assessment Team assessed R1 and determined that R1 does not qualify for a 51/50 hold. On 03/17/2025, the Los Angeles Country Department of Mental Health Psychiatric Assessment Team assess R1 and places R1 in a 51/50 hold. Based on the interviews and records this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No citations were provided.

An exit interview was conducted, and a copy of this report was left with the Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025

LIC9099 (FAS) - (06/04)

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