<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204972
Report Date: 06/18/2025
Date Signed: 06/18/2025 04:08:33 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
06/13/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20250613170729
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: 110DATE:
06/18/2025
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Administrator - Sandra LopezTIME COMPLETED:
04:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are forcing resident to take medication
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/18/2025, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced continuation complaint investigation visit regarding the allegation listed above. 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: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
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 3
Control Number 11-AS-20250613170729
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: 06/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Investigation consisted of the following:

On 06/16/2025, interviews were conducted, and records were gathered. Interviews conducted consisted of 10 resident interviews [Resident 1 (R1) to Resident 10 (R10) were interviewed] and 2 staff interviews [Staff 1 (S1) to Staff 2 (S2) were interviewed]. Resident 1’s records were gathered which consisted of Admission Agreement dated 01/01/2024, Identification and Emergency Information dated 10/26/2022, Physicians Report dated 10/10/2022, and Medication Administration Records (MAR) from 02/15/2025 to 06/14/2025. Facility records were gathered which consisted of Resident Roster dated 06/2025, and Personnel Report dated 01/2025. On 06/18/2025, interviews were conducted, records were reviewed, and a facility tour was conducted. Interviews conducted consisted of 6 staff interviews [Staff 3 (S3) to Staff 8 (S8) were interviewed]. Records reviewed consisted of R1’s records and facility records. Facility tour consisted of the medication room and the department observed staff providing medication to residents.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250613170729
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: 06/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation revealed the following: Allegation: “Staff are forcing resident to take medication”, it is being alleged that staff (specifically staff by the name of Karen) forces residents to take medication. Interviews conducted with R1 to R10 revealed the following: 1 out of 10 residents agreed with the allegation, and 9 out of 10 residents denied the allegation. Interviews conducted with S1 to S8 revealed the following: 8 out of 8 staff denied the allegation, furthermore, staff indicated that there is no staff by the name of Karen. Observations on 06/18/2025 of the medication room, revealed the following: medication technician provided medication to residents in care and did not force residents to take medication. Records reviewed of the Personnel Report dated 01/2025 revealed the following: there is no one with the name of Karen on the report. Resident 1’s records reviewed revealed the following: Physicians Report dated 10/10/2022 indicates that R1 is not able to manage their own medication nor able to administer their own injections; MAR from 02/15/2025 to 06/14/2025 indicates that R1 has been taking their medication. Based on the department’s observations, interviews, and records reviewed 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 did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited.

An exit interview was conducted, and a copy of this report was left with the Administrator, Sandra Lopez.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3