198320394-11-22-2025-11-AS-EMAZ-DQZPN2-20260205102713

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320394
Report Date: 11/22/2025
Date Signed: 11/22/2025 01:01:41 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/23/2025 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250923095522

FACILITY NAME:	ANGEL'S ON WING'S LLC		FACILITY NUMBER:	198320394
ADMINISTRATOR:	CLANTON, MARILYN		FACILITY TYPE:	740
ADDRESS:	1440 W 92ND STREET		TELEPHONE:	(310) 684-8859
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90047
CAPACITY:	6	CENSUS: 4	DATE:	11/22/2025
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Marilyn Clanton, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Unlawful eviction
Staff does not provide resident with adequate toileting assistance
Staff does not ensure residents care needs are being met
Staff does not ensure resident is spoken to in an appropriate manner
Licensee does not ensure staff are in good mental health to perform assigned duties

INVESTIGATION FINDINGS:

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On 11/22/25, at 9:05am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Caregiver, Phillip Pryce. Caregiver called Marilyn Clanton, Administrator and they arrived shortly after. LPA explained the purpose of this visit was to gather additional information and deliver findings for this complaint.

On 09/28/25, LPA Saucedo conducted the initial visit. On 09/28/25, LPA Saucedo asked for the census, staff, and resident rosters. On 09/28/25, LPA Saucedo conducted a physical tour and interviewed staff and residents. On 11/12/25, LPA Gina Saucedo conducted another physical tour and conducted additional itnterviews and record review.

LIC 9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2025

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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Control Number 11-AS-20250923095522

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: ANGEL'S ON WING'S LLC	FACILITY NUMBER: 198320394
	VISIT DATE: 11/22/2025

NARRATIVE

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Regarding the allegation: Unlawful eviction. It is being alleged that resident #1 (R1) had a week to leave the facility. During LPA’s interview with R1, R1 confirmed that they were not getting along with the administrator and wanted to leave the facility. LPA’s interview with the administrator confirmed that R1 did not want to stay there any longer and was there less than a month. LPA’s interview with witness #1 (W1) confirms that R1 called them and W1 helped them move out and was placed at another facility. LPA received R1’s admission agreement that shows R1 moved in on 09/04/25 and confirmed with W1 that R1 had left the facility by 09/22/25 with their help. W1 also confirmed that R1 was not evicted they were moved as soon as R1 called them to avoid any problems at the facility and that W1 has previously helped move R1 several times from different facilities. Therefore, based on the LPA's record review, staff, resident and witness interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff does not provide resident with adequate toileting assistance. It is being alleged that resident #1 (R1) was left multiple times in the bathroom. During LPA’s interview with R1, R1 stated, “for about 45 minutes, they were left in the bathroom unattended, they had a stroke and needed assistance with wiping themselves.” During LPA’s interview with two (2) out of the five (5) residents that need assistance with toileting, confirmed that staff do provide adequate toileting assistance, and they have never waited for 45 minutes for help. During LPA’s physical tour, LPA observed two (2) of the five (5) residents that need toileting assistance get help. The other three (3) residents do not need toileting assistance. During LPA’s interview with three (3) staff members, they confirmed R1 did need toileting assistance as well as two (2) other residents but they have never left anyone in the bathroom waiting for 45 minutes. Therefore, based on the LPA's staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

LIC 9099C-continued

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250923095522

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: ANGEL'S ON WING'S LLC	FACILITY NUMBER: 198320394
	VISIT DATE: 11/22/2025

NARRATIVE

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Regarding the allegation: Staff does not ensure residents care needs are being met. It is being alleged that the staff ignore the residents’ care needs. LPA’s interview with three (3) staff members determined that R1 needed help with several ADL’s-Activities of daily living such as toileting, changing their clothes and showering. In addition, during LPA’s record review, it was documented on R1’s admission agreement, Physician’s report and CalAIM Tier Level Assessment Form what care needs R1 needed. Furthermore, LPA interviewed five (5) residents that confirmed their care needs are met by staff. Therefore, based on the LPA's record review, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff does not ensure resident is spoken to in an appropriate manner. It is being alleged that staff are verbally abusive. During LPA’s interview with resident #1 (R1), R1 confirmed that one (1) of the staff members would be verbally abusive to them when they needed help. During LPA’s interview with five (5) residents, all five (5) residents confirmed that none of the staff members are abusive to them. LPA interviewed three (3) staff that confirmed that they have never verbally abused any of the residents. During LPA’s interview with witness #1 (W1), W1 confirmed that R1 has mental health issues and is the problematic one. During LPA’s physical tour, LPA did not witness any of the residents being verbally abused. Therefore, based on the LPA's observations, staff, resident and witness interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

Regarding the allegation: Licensee does not ensure staff are in good mental health to perform assigned duties. It is being alleged that staff work 48 hours straight and as a result the staff are tired and not in good health which also prevents the staff from properly performing the duties of their jobs. LPA interviewed five (5) residents that confirmed staff are in good mental health and help them with everything they need. Three (3) staff confirmed that they do not work 48 hours. They work 12 hour shifts with the administrator's help and are in good mental health. LPA obtained their schedule that confirms they do not work 48 hour shifts. Therefore, based on the LPA's observations, staff, resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2025

LIC9099 (FAS) - (06/04)

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