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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601983
Report Date: 02/12/2025
Date Signed: 03/20/2025 10:07:17 AM

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
02/06/2025 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20250206142847
FACILITY NAME:ST ANTHONY'S CARE HOME IIFACILITY NUMBER:
198601983
ADMINISTRATOR:SOLETA,BEULAHFACILITY TYPE:
740
ADDRESS:1724 W 254TH STREETTELEPHONE:
(310) 530-9842
CITY:LOMITASTATE: CAZIP CODE:
90717
CAPACITY:6CENSUS: 6DATE:
02/12/2025
UNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:ADMINISTRATOR BEULAH SOLETATIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
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9
Staff threatened resident
Staff do not treat resident with respect
Staff harass resident
INVESTIGATION FINDINGS:
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13
This report supersedes the report dated 02/12/2025. The investigation findings remain Unsubstantiated. The
Purpose of the amendment is to clarify the details of the investigation.
On 02/12/2025 Licensing Program Analyst (LPA) Jose Calderon and Jose Anguiano conducted an unannounced visit to the facility St. Anthonys Care Home #2 and was greeted by Administrator Beulah Soleta (S1). LPAs explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
Investigation consisted of the following: LPA’s interviewed Administrator Beulah Soleta S1, staff S1-S3, resident R1-R6. LPAs obtained and reviewed copies of the following records: Physician Report (dated 12/04/2024), Needs and Service Plan (dated 12/10/2024), Lomita Hospital record (dated 11/29/2024) for R1.
The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
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-20250206142847
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: ST ANTHONY'S CARE HOME II
FACILITY NUMBER: 198601983
VISIT DATE: 02/12/2025
NARRATIVE
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Regarding Allegation: Staff threatened resident. It is being alleged that staff threatened not to provide showers to residents and evict residents. During the investigation LPAs toured the facility and noted no negative interactions between staff and residents. Records review indicate the following: Physician Report (dated 12/04/2024) indicates that R1’s other condition includes anxiety. Needs and Service Plan (dated 12/10/2024) indicates the facility developed a plan to address R1’s feelings of anxiety, depression and confusion by assisting R1 on areas of confusion and forgetfulness. Interviews indicate the following: Staff S1- S3 denied the allegation. Resident R1 agreed with the allegation. Resident R2-R6 could not answer interview questions due to health issues. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. therefore, the allegations of “staff threatened resident” is found to be UNSUBSTANTIATED.

Regarding Allegation: Staff did not treat resident with respect. During the investigation LPAs toured the facility and noted no negative interactions between staff and residents. Records review indicate the following: Physician Report (dated 12/04/2024) indicates that R1’s other condition includes anxiety. Needs and Service Plan (dated 12/10/2024) indicates the facility developed a plan to address R1’s feelings of anxiety, depression and confusion by assisting R1 on areas of confusion and forgetfulness. Interviews indicate the following: Staff S1- S3 denied the allegation. Resident R1 agreed with the allegation. Resident R2-R6 could not answer interview questions due to health issues. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. therefore, the allegations of “staff did not treat resident with respect” is found to be UNSUBSTANTIATED.

Regarding Allegation: Staff harass resident. This complaint alleged that staff harassed R1. During the investigation LPAs toured the facility and noted no negative interactions between staff and residents. Records review indicate the following: Physician Report (dated 12/04/2024) indicates that R1’s other condition includes anxiety. Needs and Service Plan (dated 12/10/2024) indicates the facility developed a plan to address R1’s feelings of anxiety, depression and confusion by assisting R1 on areas of confusion and forgetfulness. Interviews indicate the following: Staff S1- S3 denied the allegation. Resident R1 agreed with the allegation. Resident R2-R6 could not answer interview questions due to health issues. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. therefore, the allegations of “staff harass resident” is found to be UNSUBSTANTIATED.

No deficiencies were cited. An exited interview was conducted and a copy of this report was provided to Administrator Beulah Soleta (S1)

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC9099 (FAS) - (06/04)
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