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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603550
Report Date: 01/26/2026
Date Signed: 01/26/2026 04:48:45 PM

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
12/02/2025 and conducted by Evaluator Blanca Gonzalez
COMPLAINT CONTROL NUMBER: 28-AS-20251202090428
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: 111DATE:
01/26/2026
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Jeri Miles, Executive DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not advise resident of rate change
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPA was greeted by staff and explained the reason for the visit.
The investigation consisted of the following: On 12/12/25 LPA Gonzalez conducted an initial complaint visit and obtained copies of Personnel Roster, Resident Roster, interviewed staff #1-2 (S1- S2) and obtained copies of Admission Agreement, Face Sheet, Medical Assessment, Resident Assessment, Physician’s Orders, Resident Financial Responsibility Form, and AL Advantage Residential Assessment for S1. During today’s visit, LPA interviewed staff #3-4 (S3-S4), interviewed residents #1-10 (R1-R10).
continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
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 5
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
12/02/2025 and conducted by Evaluator Blanca Gonzalez
COMPLAINT CONTROL NUMBER: 28-AS-20251202090428

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: 111DATE:
01/26/2026
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Jeri Miles, Executive DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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9
Staff did not consider resident's diertary preferences
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPA was greeted by staff and the reason for the visit was explained.
The investigation consisted of the following: On 12/12/25 LPA Gonzalez conducted an initial complaint visit and obtained copies of Personnel Roster, Resident Roster, interviewed staff #1-2 (S1- S2) and obtained copies of Admission Agreement, Face Sheet, Medical Assessment, Resident Assessment, Physician’s Orders, Resident Financial Responsibility Form, and AL Advantage Residential Assessment for S1. During today’s visit, LPA interviewed staff #3-4 (S3-S4), interviewed 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: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20251202090428
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: 01/26/2026
NARRATIVE
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Regarding the allegation “Staff did not consider resident's dietary preferences,” it is alleged that R1 had asked for soft food, no spicy food and no peppercorns. Interview with R1 revealed that their diet had been modified to soft foods and the staff are meeting their dietary needs. 7 out of 10 residents interviewed are satisfied with the food service provided and indicated their dietary needs are met. 3 out 10 residents interviewed stated they do not always like the meals being provided and are aware of alternate meal choices offered. Interview with S3 revealed a physician’s order for permanent “soft food” diet had been received 09/02/2025 for R1. S3 stated, the kitchen staff are aware of modified diets for residents and offer an alternate menu daily for residents that do not want to have the meal being offered.

Based on interviews and record review, 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 Kayla Lazo Activities Director.

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

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20251202090428
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: 01/26/2026
NARRATIVE
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The investigation revealed the following: Regarding the allegation “Staff did not advise resident of rate change,” it is alleged that R1 was not advised of their rate change prior to the increase being implemented. Interviews with S1 and S2 revealed that R1’s family was notified of the change in level of care resulting in a rate increase, However, per the facility’s Resident Financial/Responsibility Form dated 11/11/22, located in R1’s file, R1 is the responsible party and was not notified prior to implementing the change. Record review revealed, per the facility’s Resident Assessment and Service Plan, the procedure is for the Resident Care Director to ensure the service plan is signed and dated by the resident and/or responsible party, as appropriate. Per the Admission Agreement, the facility shall give sixty (60) days prior written notice of any changes in fees for levels of care, R1’s Resident assessment was dated 10/29/2025 indicating the effective date 11/01/2025, giving R1 less than sixty (60) days notice. Deficiency cited.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.


Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency is being cited on the attached LIC9099D.

Exit interview was held and a copy of this report along with the appeal rights were provided to
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20251202090428
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/02/2026
Section Cited
CCR
87507(f)
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87507(f)Admission Agreement. The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments.
This requirement is not met as evidenced by:
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Licensee agees to advise resident prior to changes. S3 will email LPA a written statement indicating the have read the admission agreement and will comply with Title 22 regulations.
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Based on interviews and record review, the licensee did not comply with the section cited above in that R1, as responsible party, was not given prior written notice of change in fees due to level of 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: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5