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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 03/30/2026
Date Signed: 03/30/2026 11:07:05 AM

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
02/20/2026 and conducted by Evaluator Mayra Cota
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260220104301
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: 143DATE:
03/30/2026
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Jaqueline Cortez, Executive DirectorTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Facility is short-staffed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced subsequent complaint investigation visit to delivery finding regarding the above-mentioned allegation. LPA met with Jacqueline Cortez, Executive, and the reason for the visit was explained.

The investigation consisted of the following:

During the initial 10-day investigation visit on 2/14/26, LPA toured common areas of the facility, obtained copies of staff and resident rosters, interviewed Staff 1 – Staff 4 (S1-S4) and Resident 1 – Resident 14 (R1-R14). LPA also obtained a copy of the Electronic Health Record (EHR) Acuity Based Staffing Estimates.

During today’s visit, LPA obtained copies of staff and resident rosters and toured the common areas of the facility. LPA also conducted interviews with Staff 5 – Staff 6 (S5-S6) during the span of the investigation.
The investigation revealed the following:
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
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 4
Control Number 28-AS-20260220104301
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: 03/30/2026
NARRATIVE
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Regarding: Facility is short-staffed.

It is alleged that the facility is often understaffed by having only two staff available to care for residents in the PM and NOC shifts on weekends. It is also alleged that diapering, bedside meal trays and wellness checks are delayed due to only two staff being on hand to provide care during a shift.

Interviews with (6) out of (6) staff revealed that the facility is short-staffed. S1-S6 indicated that there are days in which only two caregivers are providing care for the residents in the PM shift because the facility is unable to get coverage for staff who call-out staff. S1-S6 further indicated that due to staffing shortages, specifically on weekend PM shifts, services like wellness checks, bathing and incontinent care are delayed. Interview with S1 indicated that the facility follows the Electronic Health Record (EHR) Acuity Based Staffing Estimates to maintain staffing balance when scheduling staff for work; however, it has been difficult to follow the staff balance ratio populated by EHR due to the high number of staff call-outs particularly for the PM shift which is 2:00-10:00 p.m. S1 further indicated that the facility should have (6) caregivers scheduled to work in the AM, (6) caregivers in the PM and (4) caregivers in the NOC shift, scheduled to work every day for the number of residents who live in the facility and the level of care the residents need from caregivers. Interviews with S1-S2 indicated that during short-staffed days, the two to three staff who report to work will have to “run it,” which means that caregivers must divide up the assignments for care of residents between the staff on shift and additionally, provide care for residents on their workloads. S1 and S2 indicated that call-outs are immediately addressed by calling other staff who are off shift to come in to cover; however, staff cannot come in to cover.

Interviews with (10) out of (14) residents revealed that caregivers are late doing their wellness checks in the P.M. shift, two to three times a week, especially on the weekends. Residents indicated that they noticed that only two caregivers are on shift to provide care for the whole facility population and indicated that having only two staff is not enough to provide proper care for the residents who live in the facility. Eight (8) out of (14) residents indicated that caregivers are late in responding to calls from residents and have had to wait more than 20-30 minutes past the scheduled time for assistance with baths and incontinent care.

Review of the current Electronic Health Record (EHR) Acuity Based Staffing Estimates indicated that the facility should have (6) caregivers scheduled to work in the AM, (6) caregivers in the PM and (4) caregivers in the NOC shift, scheduled to work every day for the number of residents who live in the facility the average census of the facility is 140-150 for the past two months. However, the facility did not follow the EHR plan and per interviews, the facility is not using a staffing agency.

***Continues on LIC 9099-C page 2***

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20260220104301
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: 03/30/2026
NARRATIVE
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Based on information obtained from staff and residents during interviews, and review of facility’s staffing model, the allegation that the facility is short-staffed is corroborated. The preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. California Code of Regulations (Title 22), is cited on the attached LIC 9099-D. An exit interview was conducted with Jacqueline Cortez, Executive Director and a copy of this report and Appeal Rights were provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 28-AS-20260220104301
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/06/2026
Section Cited
CCR
87208(a)(5)
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Plan of Operation 87208 (a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49…(5) Staffing plan, qualifications and duties.

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Licensee/Administrator will send LPA a plan regarding how to keep staffing consistent.
Administrator will also send LPA, an updated copy of the updated staff roster.
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This requirement was not met as evidenced by: based on interviews and record review, the facility has staffing shortages which have delayed wellness checks, bathing and incontinent care for residents which poses a potential risk for persons 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.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4