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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198205095
Report Date: 07/21/2025
Date Signed: 07/21/2025 11:00:47 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
07/18/2025 and conducted by Evaluator Wendy Gibbs
COMPLAINT CONTROL NUMBER: 11-AS-20250718142100
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:
07/21/2025
UNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Antonia DionisioTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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9
Staff did not prevent a resident from developing stage 2 pressure injuries while in care
Staff did not keep facility free of insects
Staff did not ensure that resident's hygiene needs were being met
Staff did not follow physician's instructions
INVESTIGATION FINDINGS:
1
2
3
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On 07/21/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Complaint Visit to the facility listed above. LPA met with Administrator, Antonia Dionisio, and the purpose of today’s visit was explained. LPA was granted entry into the facility.
During today’s visit, LPA reviewed the Register of Residents and interviewed the Administrator/Staff S1. During the interview with Staff S1, they stated they have not had a resident by the name provided that has resided in this facility. S1 informed LPA that the resident in question resided in another facility, from December 2024 to March 2025, that they are the Administrator for but has a different Licensee.
This agency has investigated the complaint alleging Staff did not prevent a resident from developing stage 2 pressure injuries while in care, Staff did not keep facility free of insects, Staff did not ensure that resident's hygiene needs were being met, Staff did not follow physician's instructions. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis.
LPA did not observe or cite any deficiencies. An exit interview was conducted with Administrator, Antonia Dionisio, and a copy of this report was provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
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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