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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 11/08/2025
Date Signed: 11/08/2025 08:41:34 AM

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
10/16/2025 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251016123915
FACILITY NAME:SANTA ANITA ASSISTED LIVINGFACILITY NUMBER:
198603535
ADMINISTRATOR:JACQUELINE CORTEZFACILITY TYPE:
740
ADDRESS:5600 GRACEWOOD AVENUETELEPHONE:
(626) 442-8410
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY:150CENSUS: 149DATE:
11/08/2025
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Kaitlyn Gomez Med-TechTIME COMPLETED:
08:55 AM
ALLEGATION(S):
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Staff is retaliating against a resident in care for filing a complaint with licensing.
Staff did not transport resident to a medical appointment.
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 Med-Tech Kaitlyn Gomez who assisted with today’s visit.

The investigation consisted of the following: During the initial visit conducted on 10/21/2025, LPA interviewed Administrator, and residents 9 (R1-R9). LPA obtained copies of the following documents: staff roster, resident roster, R1’s physicians reports, admission agreement, identification information (LIC 601), face sheet, and transportation log. On 10/30/2025 visit LPA Gutierrez interviewed staff #2- staff #7 (S2-S7). During today’s visit LPA Gutierrez delivered findings.

SEE LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2025
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 2
Control Number 28-AS-20251016123915
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: 11/08/2025
NARRATIVE
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In regard to the allegation “Staff is retaliating against a resident in care for filing a complaint with licensing”, it is alleged that staff are retaliating against R1 for filing a complaint and are now refusing transportation to the market. During interviews with Administrator and staff seven (7) out of seven (7) stated that they do not retaliate against residents for filing complaints. Administrator stated there is a schedule for transportation and that only on Tuesdays are they able to take residents to the stores all other days are used to take residents to doctor appointments. Administrator also stated on that particular day R1 wanted to go to the market it was a Thursday and even though R1 knows the transportation schedule Administrator ordered R1 an Uber as a one-time courtesy. LPA obtained copies of the transportation schedule along with Uber receipt. During interviews with residents seven (7) out of nine (9) residents stated that staff has never retaliated against them for filing a complaint. Six (6) residents stated that they have never witnessed another resident being retaliated against either.

In regard to the allegation “Staff did not transport resident to a medical appointment”, it is alleged that in the past facility refused to transport R1 to medical appointments. During interviews with Administrator and staff seven (7) out of seven (7) stated that they have never denied transportation to a resident for medical appointments if van is full there are different ways to get a resident to appointments. Administrator stated that R1 will usually use their ride services to get to their doctors’ appointments and in the past has used facility van. S6 stated that R1 is in charge of making their own appointments and staff is told that it is none of their business who their doctor is and where their doctor is located. During interviews with residents six (6) out of nine (9) residents stated that they have never missed a ride to doctors or had any problems with the transportation the facility provides. LPA asked R1 for documents of missed doctor’s appointment and was not provided with any.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was given to Kaitlyn Gomez.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2