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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 06/11/2025
Date Signed: 06/11/2025 04:36:22 PM

Unsubstantiated


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
06/05/2025 and conducted by Evaluator Mayra Cota
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250605125710
FACILITY NAME:SANTA ANITA ASSISTED LIVINGFACILITY NUMBER:
198603535
ADMINISTRATOR:JOEL NIBBLETFACILITY TYPE:
740
ADDRESS:5600 GRACEWOOD AVENUETELEPHONE:
(626) 442-8410
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY:150CENSUS: 149DATE:
06/11/2025
UNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Jacqueline Cortez, AdministratorTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff do not ensure that residents' dietary needs are met.
Staff hit resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted an initial unannounced complaint visit to investigate the above allegations. LPA met with Jacqueline Cortez, Administrator and explained the reason for the visit.

The investigation consisted of the following:
LPA, Cota, obtained copies of client and staff rosters, toured common areas of the facility including the dining room and kitchen, conducted record review for R1 and facility menus and special dietary needs postings, and interviewed Staff 1-Staff 10 (S1-S10) and Resident 1 – Resident 14 (R1-R14).

Regarding: Staff do not ensure that residents' dietary needs are met.
It is alleged, that resident is being served fish products even though they are allergic to fish. It is also alleged that facility staff, fries all foods in the same oil that they fry fish or foods containing fish residue, staff are not preparing enough food for residents to eat, and staff are eating the meals prepared for residents.
***Continues on LIC 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
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 3
Control Number 28-AS-20250605125710
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: SANTA ANITA ASSISTED LIVING
FACILITY NUMBER: 198603535
VISIT DATE: 06/11/2025
NARRATIVE
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The investigation revealed the following:
Interviews with eight (8) staff revealed, it is mandatory for staff handling food to use gloves and hairnets to serve the food provided to the residents. Staff further stated hand washing practices are always enforced. Food handling gloves are changed between handling different food items to prevent cross-contamination. Food is covered with plastic film or refrigerated to avoid anything falling into it before it is served. Staff stated, food like fish is prepared separately from food prepared for individuals who are allergic to fish. Cutting boards are specifically assigned for the preparation of all proteins. There is also enough food for residents and food is never short. Staff stated that although kitchen staff follow healthful portion guidelines, extra food is prepared for residents who may ask for a second helping. Furthermore, snacks and other alternative food items are available to accommodate for food allergies, intolerance, religious customs, and preferences. Staff stated fish is hardly ever fried. Fish is baked in the oven and the oil in the fryer is changed constantly. Staff stated, they do not eat the food prepared for residents. Record review revealed, kitchen staff are informed by administrative staff of resident’s food allergies, intolerances, religious food customs and preferences. Staff have meetings to incorporate meal plans for residents with special dietary needs. Interviews with (13) out of (14) residents indicated, they don’t have concerns with meals not meeting their dietary needs. Residents stated, they observe kitchen staff use gloves and hairnets when serving their food. Residents stated, they have enough food to eat, and a variety of snacks are available in the front office like fruit and sandwiches after kitchen is closed. Residents stated, they like the food, and they know there is an alternate menu they can resort to when they don’t like the meal on the menu for the day. Residents stated, fried food is not served often, and fish is backed or grilled. Residents stated, if there is a change in their dietary needs, the kitchen staff will make the accommodations they need to get the appropriate food in their diet. LPA conducted tour of the dining room and kitchen and observed all staff wearing gloves and hairnets during food preparation. LPA also observed, staff practicing hand washing and glove replacement after contact with different food items. Food preparation and cooking areas were observed, and stove tops, grills, griddles and fryers were also observed clean. Food was observed covered appropriately before being served and portions met the nutritional guidelines. At the time of visit, LPA did not observed staff eating resident’s food, nor any other food items during their work shift. Staff and resident interviews, record review and LPA observation, do not corroborate the allegation. Record review indicated, there is a standard menu in place in addition to a menu with alternative food choices which are available daily. Record review and interview with R1 do not indicate a reactions has occurred.


Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.
****Contines on LIC 9099-C
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250605125710
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: SANTA ANITA ASSISTED LIVING
FACILITY NUMBER: 198603535
VISIT DATE: 06/11/2025
NARRATIVE
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Exit interview conducted with Alisa Dean, Business Office Manager due to Administrator leaving the facility for a prior engagement, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3