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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601838
Report Date: 06/28/2025
Date Signed: 06/28/2025 03:00:36 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/09/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250609093135
FACILITY NAME:DOWNEY RETIREMENT CENTERFACILITY NUMBER:
198601838
ADMINISTRATOR:BRANDIE MENDIBLESFACILITY TYPE:
740
ADDRESS:11500 DOLAN AVENUETELEPHONE:
(562) 869-2416
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:252CENSUS: 132DATE:
06/28/2025
UNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:LVN- Jorge PenaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Staff did not ensure the facility was free of pests.
Unqualified staff providing care to residents.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 06/28/2025 to deliver findings regarding the above allegations. LPA Ramirez conducted an initial complaint visit on 06/17/2025 and a need further investigation was documented. During today’s visit, LPA Ramirez was greeted by staff Juan Garcia and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Staff#1 - 4 interviews (S1 – S4), Resident#1-10 (R1-R10), Orkin Pest Control Services Reports dated 01/2025 through 05/2025, Caregiver Response To Residents Care Log for the month of 06/2025, In-Service Training Logs for 01/2024 through 12/2024, In-Service Training Sign-in Sheet for 05/28/2025, Direct Care Orientation Training Checklist for staff#4 (S4), Dementia Care Staff Training for staff#3 (S3), and physical plant tour.

SEE 9099-C
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025
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 6
Control Number 28-AS-20250609093135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: DOWNEY RETIREMENT CENTER
FACILITY NUMBER: 198601838
VISIT DATE: 06/28/2025
NARRATIVE
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The investigation revealed the following: regarding the allegation “Staff did not ensure the facility was free of pests.” It is alleged the facility has pests throughout the facility. Ten (10) out of the ten (10) residents interviewed corroborated this allegation. During record review, LPA Ramirez reviewed Orkin Service Report dated 05/28/2025, revealed Orkin pest technician documented “I found German roaches and set up new monitors, and I suggested to (S2) to add a one more scope of service of month to get the issue under control (202, 210, 211, 223, 234, and 124).” During facility tour on 06/17/2025, LPA Ramirez observed live roaches in disposable roach glue traps in resident room#111. Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.


“Unqualified staff providing care to residents.” It is alleged that staff are not properly trained or certified to be caregiver. Four (4) out of the four (4) staff interviewed denied this allegation. Ten (10) out the ten (10) residents interviewed denied this allegation. During record review, LPA Ramirez observed Direct Care Orientation Training Checklist for staff#4 (S4) dated 04/10/2024 and Dementia Care Staff Training for staff#3 (S3) dated 03/01/2023. LPA Ramirez reviewed and obtained In-Service Training Logs for 01/2024 through 12/2024 and In-Service Training Sign-in Sheet for 05/28/2025. In-Service Training logs for 01/2024 through 12/2024 did not reflect required annual training hours and training topics on dementia, postural supports, restricted health conditions, and hospice care, as required by Title 22, Division 6, Health and Safety Code, Chapter 03.2 Residential Care Facilities for the Elderly, Article 06. Other Provisions- Staff Trainings 1569.625. LPA Ramirez observed various training including the following trainings in for 2024: Shift Report-Elderly Needs dated 01/11/2024, Burnout dated 01/25/2024, Kitchen Safety dated 02/01/2024, Emergency Shut off dated 02/29/2024, Resident Right-Proper entry into resident rooms dated 03/13/2024, Mobility, Falls, and Dementia dated 06/27/2024, Postural Supports/ Dementia dated 10/24/2024, and change in condition dated 11/14/2024. Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

Four (4) deficiencies were cited as result of this complaint investigation. Exit interview was conducted and a copy of this report was provided via email. A copy of this report, 9099-D and appeals rights was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/09/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250609093135

FACILITY NAME:DOWNEY RETIREMENT CENTERFACILITY NUMBER:
198601838
ADMINISTRATOR:BRANDIE MENDIBLESFACILITY TYPE:
740
ADDRESS:11500 DOLAN AVENUETELEPHONE:
(562) 869-2416
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:252CENSUS: 132DATE:
06/28/2025
UNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:LVN- Jorge PenaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not responding to residents call button in a timely manner.
Staff are not providing adequate food service to residents.
INVESTIGATION FINDINGS:
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3
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5
6
7
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10
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13
Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 06/28/2025 to deliver findings regarding the above allegations. LPA Ramirez conducted an initial complaint visit on 06/17/2025 and a need further investigation was documented. During today’s visit, LPA Ramirez was greeted by staff Juan Garcia and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Staff#1 - 4 interviews (S1 – S4), Resident#1-10 (R1-R10), Orkin Pest Control Services Reports dated 01/2025 through 05/2025, Caregiver Response To Residents Care Log for the month of 06/2025, In-Service Training Logs for 01/2024 through 12/2024, In-Service Training Sign-in Sheet for 05/28/2025, Direct Care Orientation Training Checklist for staff#4 (S4), Dementia Care Staff Training for staff#3 (S3), and physical plant tour.

SEE 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 28-AS-20250609093135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: DOWNEY RETIREMENT CENTER
FACILITY NUMBER: 198601838
VISIT DATE: 06/28/2025
NARRATIVE
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The investigation revealed the following: regarding the allegation “Staff are not responding to residents call button in a timely manner.” It is alleged that staff are not responding to residents call button in a timely manner. Ten (10) out of the ten (10) residents interviewed denied this allegation. Four (4) out of the four (4) staff interviewed denied this allegation. LPA Ramirez tested call button in random rooms during facility tour and staff responded in a timely manner. Review of Caregiver Response To Residents Care Log for the month of 05/2025 and 06/2025, did not corroborate this allegation. 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.

Staff are not providing adequate food service to residents. It is alleged staff are not providing adequate food service to residents and making residents ill. Ten (10) out of the ten (10) residents interviewed denied this allegation. Four (4) out of the four (4) staff interviewed denied this allegation. LPA Ramirez toured facility kitchen and observed all refrigerators and freezers to be operational. LPA Ramirez did not observe spoiled or rancid food items on serving plates or in pantry. LPA Ramirez observed staff wearing gloves while handling food. During record review, LPA Ramirez did not observe incident reports that indicated residents became ill due to food provided by the facility. 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 for these allegations. Exit interview was conducted. A copy of this report was provided via email.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20250609093135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DOWNEY RETIREMENT CENTER
FACILITY NUMBER: 198601838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/29/2025
Section Cited
CCR
87555(b)(27)
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(b)The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met as evidenced by:
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Staff agreed to send a plan to address how the facility plans to keep the kitchen area free from insects by 6/29/25. Proof from pest control services that the facility kitchen area is free from insects, is due by July 7, 2025. Proof must be sent via email to LPA Ramirez.
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on 5/28/25, massive roach infestation was observed in the facility kitchen area. This poses a immediate risk to the health, safety, or personal rights of persons in care.
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Type B
07/07/2025
Section Cited
CCR
87303(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Staff agreed to send a plan to address how the facility plans to keep these rooms sanitary. Proof must be sent via email to LPA Ramirez.
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This requirement was not met as evidenced by: rooms 202,210,211,223 234 and 124 are not kept sanitary due to roaches infestation not being kept under control. LPA Ramirez observation of live roach in trap. Staff not adhereing to pest control recommendations to rid theses rooms of insects.
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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.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20250609093135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DOWNEY RETIREMENT CENTER
FACILITY NUMBER: 198601838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2025
Section Cited
CCR
87411(c)
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(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. This requirement was not met as evidenced by: based on records reviewed caregivers did not receive annual training
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Administrator will certify plan on how caregivers will receive initial and annual training according to this regulation. Plan must be received by 7/7/25.
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 as specified in H&S 1569.625 and 1569.69.
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Type B
07/07/2025
Section Cited
CCR
87412(c)(2)(D)
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(c) Licensees shall maintain in the personnel records verification of required staff training and orientation.(2)Documentation of staff training shall include: (D) Number of training hours per subject. This requirement was not met as evidenced by:
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Administrator will certify plan on how the facility will document training hours for staff. Plan must be received by 7/7/25.
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documentation of staff training did not reflect number of training hours per subject.
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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.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6