<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603712
Report Date: 12/02/2025
Date Signed: 12/02/2025 01:08:59 PM

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
11/24/2025 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251124142014
FACILITY NAME:GRANT SERENITY OF MONROVIA INCFACILITY NUMBER:
198603712
ADMINISTRATOR:GEVORKIAN, NVARDFACILITY TYPE:
740
ADDRESS:823 E LEMON AVETELEPHONE:
(818) 425-6797
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY:6CENSUS: 5DATE:
12/02/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Staff S1TIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained injury due to staff neglect.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Staff S1 and explained the reason for the visit.
The purpose of the visit is to conduct a 10 day complaint visit in regards to the above allegation.
Shortly thereafter Assistant Administrator Diana Castellanos arrived.
At today's visit 12/02/25 the following was done:
Staff S1- Staff S4 were interviewed. S3 and S4 were interviewed telephonically.
Assistant Administrator Diana Castellanos was interviewed.
Resident's R2-R5 were interviewed. Attempts to interview Resident R6 were unsuccessful as R6 was unable to respond to questions being non-verbal.
Private Caregiver for Resident R1 was interviewed.
Hospice Nurse for Resident R1 was interviewed.
File of Resident R1 was reviewed and Physician's Report, Admissions Agreement and Emergency Face Sheet to be submitted.





Resident and Staff Roster submitted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
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-20251124142014
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: GRANT SERENITY OF MONROVIA INC
FACILITY NUMBER: 198603712
VISIT DATE: 12/02/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In regards to the allegation Resident sustained injury due to staff neglect, based on interviews conducted and information gathered it was revealed by the Hospice Nurse that signs of abuse were not observed.
Said there were no bruises from a fall and no bleeding.
Interview with Resident R2- R5 who stated that staff treats them well and they assist with food, medication and hygiene.
Have not had any issues with neglect and that they were unaware of Resident R1's alleged incident.
Primary Caregiver stated that Resident R1's mouth was cleaned inn the bathroom and had all teeth after that.
Not sure what occurred, but said Resident R1 has gum disease and it could be old and decaying and R1 lost it.
Assistant Administrator stated that R1 had own private caregiver till R1 was comfortable at the facility.
Stated that the private caregiver brushed R1's teeth and was at the facility for most of R1's stay and said private caregiver didn't notice anything.
Staff S1- S4 all stated that R1's private caregiver was with R1 and brushed R1's teeth and took care of R1's feedings.
All stated they did not observe any neglect of R1 or any resident and said they treat all residents well.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted with Assistant Administrator Diana Castellanos and report issued.


SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2