198601887-10-2-2025-11-AS-EMAZ-DMQQM8-20251023121707

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601887
Report Date: 10/02/2025
Date Signed: 10/02/2025 04:42:15 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
09/25/2025 and conducted by Evaluator Troy Watson

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250925142530

FACILITY NAME:	VELEZ CARE HOME		FACILITY NUMBER:	198601887
ADMINISTRATOR:	CHILLY LYN NAVARRO		FACILITY TYPE:	740
ADDRESS:	2120 VELEZ DRIVE		TELEPHONE:	(213) 880-1629
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY:	4	CENSUS: 4	DATE:	10/02/2025
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	ALBERTA CALDIZ		TIME COMPLETED:	04:42 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee does not ensure enough night staff to meet the needs of residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/02/2025 Licensing Program Analyst (LPA) Troy Watson conducted an initial complaint visit to the facility listed above. LPA met with the Direct Support Professional (DSP) Alberta Caldiz and the purpose of the visit was explained. LPA Watson was granted entry into the facility.

The investigation consisted of the following:

On 10/02/2025 Licensing Program Analyst (LPA) Watson requested, reviewed, and obtained a copy of the Resident Roster, Staff Schedule, Behavioral Reports, and Medical Administration Records (MAR’s). LPA Watson was later greeted by the Assistant Administrator Josefina Guiao. LPA Watson toured the facility with the assistant administrator and found the facility clean and in good repair.

CONTINUED ON LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

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 2

Control Number 11-AS-20250925142530

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: VELEZ CARE HOME	FACILITY NUMBER: 198601887
	VISIT DATE: 10/02/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:

Allegation: Licensee does not ensure enough night staff to meet the needs of residents.

On 10/02/2025 LPA Watson conducted interviews with Staff #1 – Staff#4 (S1-S4) about the allegation listed above. Out of those interviewed 4 out of 4 staff interviewed denied the allegation. On 10/02/2025 LPA Watson conducted interviews with Residents #3 - Residents #4 (R3-R4) about the allegation listed above. Out of those interviewed 2 out of 2 residents denied the allegation. An attempt to interview both Resident #1- Resident #2 (R1-R2) was made, but Resident #1(R1) was not in the facility at the time of visit. An attempt to conduct an interview R1 was made by calling the Lomita Post Acute Care Center Hospital. R1 was unable to intelligibly respond to the interview questions. An attempt to conduct an interview with Resident #2 was made at the facility but R2 refused to answer any interview questions. LPA Watson requested, obtained and reviewed the Staff Schedule and found that the facility was adequately supplied with night staff to meet the resident’s needs. Based on the information gathered, interviews conducted, and review of records LPA Watson found no evidence to support the allegation mentioned above. 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.

An exit interview was conducted with the Assistant Administrator Josefina Guiao and a copy of this report was provided

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2