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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204972
Report Date: 04/04/2025
Date Signed: 04/04/2025 05:06:16 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
03/27/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20250327160411
FACILITY NAME:ROSECRANS VILLA RESIDENTIAL CAREFACILITY NUMBER:
198204972
ADMINISTRATOR:SANDRA LOPEZFACILITY TYPE:
740
ADDRESS:14110 CORDARY AVENUETELEPHONE:
(310) 675-9163
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:135CENSUS: 112DATE:
04/04/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator - Sandra LopezTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Financial abuse to resident.
Staff are not ensuring that facility is free of pest.
Staff are not ensuring residents are provided a safe environment.
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 5
Control Number 11-AS-20250327160411
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 Resident 1’s (R1s) room. Interviews consisted of 3 staff interviews [Staff 1 (S1) to Staff 3 (S3) were interviewed] and 1 resident interviews (R1 was interviewed). Facility records reviewed consisted of Personnel Report dated 01/2025, Register of Facility Residents dated 01/01/2025, Pest Control documents from 01/2025 to 03/2025. Resident 1 (R1) records reviewed consisted of Admission Agreement dated 01/01/2024, Physicians Report dated 06/13/2024, Appraisal & Needs Services Plan dated 01/28/2025, pictures of his room dated 3/20/2024, Record of Resident’s Safeguard Cash Resources for the year of 2025, 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 5
Control Number 11-AS-20250327160411
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: “Financial Abuse to resident”, it is being alleged that the facility is financially abusing R1. Interview conducted with the Administrator (S1) revealed the following: S1 denied the allegation. Interview conducted with R1 revealed the following: R1 denied the allegation. Records reviewed of R1’s Record of Resident’s Safeguard Cash Resources for the year of 2025 revealed the following: it depicts that R1 has been receiving their money and each entry has a staff signature and R1’s signature. 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 5
Control Number 11-AS-20250327160411
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 are not ensuring that facility is free of pest”, it is being alleged that R1’s room has maggots, cockroaches, and flies. Observation on 04/04/2025 of R1’s room revealed the following: the department did not observe maggots, live cockroaches, and flies. Records reviewed of the Pest Control documents from 01/2025 to 03/2025 revealed the following: the Pest Control Company comes to the facility 4 times per month to 3 times per month, furthermore, R1’s room was fumigated on 02/07/2025, 02/25/2025, and 03/20/2025. Interview conducted with R1 revealed the following: R1 denied the allegation. Interviews conducted with S1 to S3 revealed the following: S1 indicated that R1 had been placed in 51/50 hold and during that time the facility deep cleaned his room, furthermore, S2 and S3 corroborated with S1’s story. Moreover, S1 to S3 indicated that as of right now R1’s room does not have maggots, flies, and roaches. 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: 4 of 5
Control Number 11-AS-20250327160411
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 are not ensuring residents are provided a safe environment”, it is being alleged that R1’s room is unsafe because they have a heather on their bed and staff does nothing to ensure that R1 has a safe environment. Observations on 04/04/2025 of R1’s room revealed the following: the department observed a heather on R1’s bed. Interview conducted with R1 revealed the following: R1 indicated that staff have informed him to remove the heater from their bed, but they do not feel that it is danger to place the heater on the bed, moreover, they get annoyed when staff moves their heater to the floor. Interviews conducted with S1 to S3 revealed the following: 3 out 3 staff denied the allegation, 2 out 3 staff indicated that they have talked to R1 about placing the heater on the floor, 2 out 3 staff indicated that they have moved the heater to the floor. Based on the interviews 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.

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)
Page: 5 of 5