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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320492
Report Date: 08/21/2025
Date Signed: 08/21/2025 04:53:56 PM

Substantiated


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
08/06/2025 and conducted by Evaluator Regina Cloyd
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250806161340
FACILITY NAME:CERISE GUEST HOMEFACILITY NUMBER:
198320492
ADMINISTRATOR:DEMAFELIX, JEHN MARICFACILITY TYPE:
740
ADDRESS:22525 CERISE AVENUETELEPHONE:
(310) 533-1131
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:6CENSUS: 3DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
12:51 PM
MET WITH:JM DemafelixTIME COMPLETED:
05:07 PM
ALLEGATION(S):
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Unlawful eviction.
Staff abandoned resident.
INVESTIGATION FINDINGS:
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On 08/13/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an initial visit on to gather information regarding the above allegation. LPA met with House Manager Benito “Jun” Laserna and the purpose of the visit was explained. LPA spoke with Administrator JM Demafelix over the phone. On 08/21/25, LPA met with Administrator and Staff.

Investigation consisted of the following: On 08/13/2025, LPA obtained a Register of Residents (dated 05/02/25), and Resident #1’s Physician’s Report (09/09/24), and Needs and Services plan (dated 04/07/25). LPA interviewed Staff #1 – 2. LPA received Torrance Memorial Hospital Medical Records for R1. On 08/14/25, LPA received R1’s Incident Report (04/18/25 and 07/21/25), Appraisal (04/07/25), Physician’s Report (09/09/24), Admission Agreement, SOC 341 (updated 05/05/25), and Eviction Notice (04/14/25). On 08/15/25, LPA received Torrance Memorial Hospital Clinical Notes. On 08/19/25, LPA received R1’s Pre-Appraisal (09/06/24). On 08/21/25, LPA interviewed Staff #1 – 3.
Continue to LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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 4
Control Number 11-AS-20250806161340
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: CERISE GUEST HOME
FACILITY NUMBER: 198320492
VISIT DATE: 08/21/2025
NARRATIVE
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Investigation revealed the following:
Allegation: Unlawful eviction.

Record review of the eviction noticed (04/14/25) indicated that R1’s final residency would be 05/14/25. The notice did not include the following requirements: resources available to assist in identifying alternative housing and care options, a statement informing residents of their right to file a complaint with the licensing agency including the name, address and telephone number of the licensing office with whom the licensee normally conducts business, and the State Long Term Care Ombudsman office, and the following exact statement as specified in Health and Safety Code Section 1569.683(a)(4): "In order to evict a resident who remains in the facility after the effective date of the eviction, the residential care facility for the elderly must file an unlawful detainer action in superior court and receive a written judgment signed by a judge. If the facility pursues the unlawful detainer action, you must be served with a summons and complaint. You have the right to contest the eviction in writing and through a hearing."

Regarding the allegation, “Unlawful eviction,” based on record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Allegation: Staff abandoned resident.

Regarding the allegation, “Staff abandoned resident,” it is being alleged that Resident #1 (R1) was ready for discharge, but the Administrator (S1) refused to accept R1. Record review of Incident Report (07/21/25) revealed R1 complained about mid-section pain. Staff #2 (S2) recommended calling 911 but Witness #1 (W1) stated W1 would take R1. W1 texted S2 on 07/22/25 explaining that R1 would be in the hospital for 10 days to 2 weeks due to UTI. Review of text messages initiated by S1 with W1 revealed that S1 inquired about R1’s location so that S1 could speak with case management about appropriate placement (07/22/25), S1 requested to speak with case manager prior to R1’s return to determine higher level of care (07/28/25), and S1 acknowledged S1 was able to speak with someone from the hospital (07/29/25). Record review of Social Worker notes revealed that the hospital called S1 on 07/29/25, 07/31/25, and 08/06/25 and S1 refused to accept R1 due to R1’s need for a higher level of care. Continue to LIC9099-C.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20250806161340
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: CERISE GUEST HOME
FACILITY NUMBER: 198320492
VISIT DATE: 08/21/2025
NARRATIVE
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 Discharge summary (07/28/25) revealed R1’s diagnosed conditions that were consistent with R1’s Pre-placement Appraisal (09/06/24), Physician's Report (09/09/24) and Reappraisal (04/07/25). The facility’s Plan of Operation for Dementia Care revealed the facility has special techniques for managing behavioral expressions such as avoiding aggressive behaviors, sundowning, and threatening (verbal and nonverbal). Interview with S1 indicated that R1’s behaviors got worse and R1 was throwing things at the dining table, hitting, and scratching. S1 indicated special techniques would have probably worked with W1 and skilled professional support.

Regarding the allegation, “Staff abandoned resident,” based on record reviews and interviews, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D

An exit interview was conducted, plans of correction developed, and a copy of this report with appeal rights were provided to Area Manager Irene Formentera.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20250806161340
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: CERISE GUEST HOME
FACILITY NUMBER: 198320492
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/08/2025
Section Cited
CCR
87224(d)(1)
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The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. (1) The notice to quit shall include the following information:
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The Licensee will submit a plan of correction to regina.cloyd@dss.ca.gov by the POC due date. The Licesee will also follow the reporting requirements by notifying Licensing of future evictions.
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This requirement was not met as evidence by:

Based on record view of the 30-day notice, the Licensee did not include all of the requirements outline in 87224(d)(1)(B) - 87224(d)(1)(D) which posed a potential personal rights risk to resident in care.
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Request Denied
Type B
09/08/2025
Section Cited
CCR
87468.1(a)(2)
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(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations...

This requirement was not met as evidence by:
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The Licensee will provide proof of correction to regina.cloyd@dss.ca.gov by the POC due date.
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Based on record review and interviews, the Licensee did not permit R1 to return back to the facility which posed a potential personal rights risk to the resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4