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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603535
Report Date: 06/18/2026
Date Signed: 06/18/2026 10:35:59 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/05/2026 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20260605093049
FACILITY NAME:SANTA ANITA ASSISTED LIVINGFACILITY NUMBER:
198603535
ADMINISTRATOR:ALISA DEANFACILITY TYPE:
740
ADDRESS:5600 GRACEWOOD AVENUETELEPHONE:
(626) 442-8410
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY:150CENSUS: 144DATE:
06/18/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Alisa DeanTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility staff did not provide adequate supervision resulting in a resident being attacked by another resident.
INVESTIGATION FINDINGS:
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On 6/18/2026 at 09:30 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted two subsequent complaint investigations. The purpose of the visit was explained to Administrator Alisa Dean.

During the visit on 6/15/2026, LPA obtained the resident roster, staff roster, physician's report for R2, notes and incidents for R2, and the admissions agreement for R2, and the house rules. LPA interviewed the administrator and four (4) staff members, who shall be referred to as Staff #1 through Staff #4 (S1-S4). LPA also interviewed 10 residents, who will be referred to as resident #1 through #10 (R1-R10). LPA attempted to interview a former staff member (FM).

Prior to the visit, LPA attempted to contact the former staff member (FM) but was unable to interview them.

Report Continued on 9099c
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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 2
Control Number 28-AS-20260605093049
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SANTA ANITA ASSISTED LIVING
FACILITY NUMBER: 198603535
VISIT DATE: 06/18/2026
NARRATIVE
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The investigation reveals the following: “Facility staff did not provide adequate supervision, resulting in a resident being attacked by another resident. ”It is alleged that R2 attacked R1 while R1 was exiting the medication room. According to the incident report submitted on 5/16/2026 and the charting notes from FM, the altercation involved R1 asking R2 to move out of the way, and R2 refused to move. R2 pushed and grabbed R1, and R1 almost lost there balance. FM separated both residents. According to the administrator and all staff, R2 usually stays to themselves but is confused and easily irritable. They further stated that this is the first incident in which things have gotten physical involving R2. The police were notified and spoke to both residents. 3 out of 10 residents stated they do not know R2. 3 out of 10 stated they had never witnessed any physical incidents involving R2 but knew R2 to have a temper. They further stated they have heard rumors about R2. 1 out of 10 residents stated they have heard rumors but do not wish to talk about R2 because they are unsure if they are true. 2 out of 10 stated they have witnessed R2 becoming physically aggressive with either themselves or other residents. R2 denied being physically violent with the other residents and stated R1 was trying to control them. After reviewing R2’s file, it was concluded that R2 is not on a 1-1.

Based on LPA's interviews, the investigation revealed that, although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove whether the alleged violation did or did not occur; the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Administrator Alisa Dean, and a copy of this record was provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
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