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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603550
Report Date: 12/12/2025
Date Signed: 12/12/2025 03:53:12 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
12/05/2025 and conducted by Evaluator Blanca Gonzalez
COMPLAINT CONTROL NUMBER: 28-AS-20251205120229
FACILITY NAME:WEST PARK SENIOR LIVINGFACILITY NUMBER:
198603550
ADMINISTRATOR:JERI MILESFACILITY TYPE:
740
ADDRESS:801 CYPRESS WAYTELEPHONE:
(909) 592-8844
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:200CENSUS: 113DATE:
12/12/2025
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Jeri Miles, Executive DirectorTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Licensee did not ensure equipment was in good repair
Licensee did not ensure resident was afforded dignity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced initial complaint investigation visit on 12/12/2025 regarding the above allegations. During today’s visit, LPA Gonzalez was greeted by Executive Director Jeri Miles and the purpose of the visit was explained.

The investigation consisted of the following: LPA Gonzalez requested and obtained copies of Personnel Roster, Resident Roster, Admission Agreement, invoice for services provided, maintenance log, interviewed staff #1-4 (S1- S4) and Residents #1-10 (R1-R10).

Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
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-20251205120229
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: WEST PARK SENIOR LIVING
FACILITY NUMBER: 198603550
VISIT DATE: 12/12/2025
NARRATIVE
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continued from LIC 9099

The investigation revealed the following:
Regarding the allegation "Licensee did not ensure equipment was in good repair," it is alleged that residents have not had television service for five weeks. Interviews with staff revealed 4 out of 4 staff deny the allegation. Staff indicated there had been technical issues with a service provider but the issues were resolved within a week of the initial complaint. Interviews with residents revealed 1 out of 10 residents interviewed stated there are ongoing problems, service hasn't been consistent for months. 2 out of 10 residents indicated just recently there was an issue with service but it had been quickly resolved. 7 out of 10 residents indicated they had not had any problems with their television service.

Regarding the allegation "Licensee did not ensure resident was afforded dignity," it is alleged that when resident advised staff of the television service issue, staff laughed and disregarded the resident. Interviews with residents revealed 10 out 10 residents did not have concerns. Residents stated staff is respectful when residents address concerns. !0 out of 10 residents stated they had not heard anyone complain about staff laughing at a resident after expressing a concern. R3 stated "no concerns, this place is beautiful." R10 stated "they try their best."

Based on interviews and observation, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to Executive Director Jeri Miles.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
LIC9099 (FAS) - (06/04)
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