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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198205095
Report Date: 01/14/2025
Date Signed: 01/14/2025 11:09:14 AM

Unfounded


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
01/07/2025 and conducted by Evaluator Regina Cloyd
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250107131136
FACILITY NAME:SOUTH BAY RESIDENTIAL CARE HOMEFACILITY NUMBER:
198205095
ADMINISTRATOR:ELVIRA DAVIDFACILITY TYPE:
740
ADDRESS:2460 W. 229TH PLACETELEPHONE:
(310) 534-1953
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:6CENSUS: 4DATE:
01/14/2025
UNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Administrator Antonia DionisioTIME COMPLETED:
11:10 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff mistreated resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 01/14/25, Community Care Licensing Division (CCLD) Staff conducted an unannounced complaint visit to the facility listed above. CCLD met with Administrator Antonia Dionisio and explained the purpose of today’s visit. During today’s visit CCLD reviewed the register of residents and interviewed Administrator/Staff #1 and Resident #1 (R1) over the phone.

The investigation revealed the following:

CCLD has investigated the complaint alleging staff mistreated resident. Register of residents (LIC 9020) revealed R1 did not live at the address listed above. Interview with R1 indicated R1 did not live at the address listed above. Interview with S1 indicated R1 has never lived at the adresss listed above. Based on record review and interviews, CCLD found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. An exit interview was conducted with Administrator Antonia Dionisio and a copy of this report was provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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