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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602557
Report Date: 07/08/2025
Date Signed: 07/08/2025 12:58:37 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
06/26/2025 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250626142210
FACILITY NAME:ALONDRA GUEST HOMEFACILITY NUMBER:
198602557
ADMINISTRATOR:VILLAFLORES, LOURDESFACILITY TYPE:
740
ADDRESS:11849 ALONDRA BLVDTELEPHONE:
(562) 863-7630
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:6CENSUS: 2DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Administrator Lourdes VillafloresTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Staff serves expired food to resident.
Staff does not provide resident with nutritious meals
Staff is not meeting the resident's medical needs.
Staff does not maintain adequate records for resident.
staff mismanages resident's medications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Administrator Lourdes Villaflores and explained the purpose of the visit.

The investigation consisted of the following: During the initial visit conducted on 06/30/2025, LPA interviewed Administrator, staff (S1) and resident's R1-R2. LPA toured the facility kitchen, garage, and resident (R1’s) bedroom and obtained copies of the following documents: staff roster, resident roster, R1’ appraisal needs and service plan, physicians’ reports, admission agreement, identification information (LIC 601), medication record sheet, and hospital discharge paperwork. During today’s visit LPA Gutierrez delivered findings.

SEE 9099C
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
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-20250626142210
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: ALONDRA GUEST HOME
FACILITY NUMBER: 198602557
VISIT DATE: 07/08/2025
NARRATIVE
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In regard to the allegation “Staff serves expired food to resident’ and “Staff does not provide resident with nutritious meals”, it is alleged that facility keeps expired food and that residents are not being served nutritious meals. During interviews with Administrator and staff (S1) both stated that they do not have expired food and that both residents receive well balanced nutritional food. During interviews with residents R1 and R2 both stated that the food is okay. R1 stated that they don’t get enough food. LPA Gutierrez checked food supply and observed expired milk, cheese, sour cream, and molded cauliflower in refrigerator. LPA also toured garage and found a supply of vegetables and expired bread with gnats surrounding boxes. During visit LPA Gutierrez observed Administrator serve R1 tacos with the three month expired sour cream. LPA asked Administrator to throw away all expired food.

In regard to the allegation “Staff is not meeting the resident's medical needs”, it is alleged that R1 was referred to an ophthalmologist and urologist in June of 2020 and was never taken. During interviews with Administered it was reveled that R1 was not taken to appointments because Administrator thought that home health care was supposed to arrange that, and the facility does not provide those services. S1 stated that he/she doesn’t take care of medical appointments. During interviews with residents R1 stated that he/she has only seen the doctor once and R2 stated that family takes he/she to doctors.

In regard to the allegation “Staff does not maintain adequate records for resident”, It is alleged that R1’s file is not updated with current paperwork. During record review it was reveled that R1 has not seen a physician for an updated physicians report LIC 602 since 06/16/2020 with a diagnosis of Dementia, and the appraisal needs, and service plan was not completed, nor did it have R1’s signature or signature of person completing form. During interview with Administrator, it was revealed that home health care has been seeing R1 and no updated LIC 602 has been completed by physician.

SEE LIC 809C

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20250626142210
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: ALONDRA GUEST HOME
FACILITY NUMBER: 198602557
VISIT DATE: 07/08/2025
NARRATIVE
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In regard to the allegation “staff mismanages resident's medications”, it is alleged that facility did not have an updated centrally stored medication list since 2020. During record review it was reveled that facility did have current centrally stored medication log from May of 2025. LPA did a medication check and Atrovent Inhaler was missing for R1. Administrator stated R1 did not use inhaler, but doctor has never discontinued inhaler for R1.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code.

An exit interview was conducted with Administrator Lourdes VillaFlores. A copy of the report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 28-AS-20250626142210
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: ALONDRA GUEST HOME
FACILITY NUMBER: 198602557
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/09/2025
Section Cited
CCR
87555(b)(8)
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87555 General Food Service Requirements
(b) The following food service requirements shall apply:
(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained.


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Administrator will purchase fresh fruit, meat and produce and send LPA pictures as proof. Administrator will create a log and check food for expiration dates and ensure food is free from gnats.
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Based on observation facility had expired sour cream, milk, cheese, bread and vegetables in refrigerator.LPA observed gnats on food. This poses an immediate health and safety risk to residents in care.

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Type A
07/09/2025
Section Cited
CCR
87555(a)
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87555 General Food Service Requirements
(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.


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Administrator will conduct a training for herself and staff of the importance of serving a nutritional well-balanced meal and send training to LPA by POC due date. Administrator also agrees to check for expiration dates before serving residents.
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Based on observation LPA observed Administrator serve R1 Three month expired sour cream for lunch. This poses an immediate health and safety risk to residents 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.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20250626142210
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: ALONDRA GUEST HOME
FACILITY NUMBER: 198602557
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2025
Section Cited
CCR
87468.1(a)(16)
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87468.1 Personal Rights of Residents in All Facilities
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:
(16) To receive or reject medical care or other services.

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Administrator will contact physician for new referrals and send LPA dates for appointments.
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Based on record review R1 was given two referrals for ophthalmologist and urologist appointments were never made which poses a potential risk to residents in care.



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Type B
07/29/2025
Section Cited
CCR
87506(a)
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87506 Resident Records
(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.

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Administrator will submit new physicians report LIC 602 and complete an appraisal needs and service plan by POC due date.
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Based on record review R1 has not had an updated physician’s (602) report since 2020. R1’s appraisal needs, and service plan is incomplete.

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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: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20250626142210
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: ALONDRA GUEST HOME
FACILITY NUMBER: 198602557
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/09/2025
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care
a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
(4) The licensee shall assist residents with self-administered medications as needed.

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Administrator will contact pharmacy for inhaler and send LPA picture once inhaler is received.

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Based on record review R1 di not have Atrovent NFA Inhaler 2 puffs by mouth every 4 hours with spacer (routinely). This poses an immediate health and safety risk to residents 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.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6