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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300613262
Report Date: 09/11/2025
Date Signed: 09/11/2025 12:36:59 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/10/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250910084428
FACILITY NAME:NEW ERA GUEST HOMEFACILITY NUMBER:
300613262
ADMINISTRATOR:GUTIERREZ, JOSEFINA P.FACILITY TYPE:
740
ADDRESS:12692 BLACKTHORN ST.TELEPHONE:
(714) 537-1282
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:6CENSUS: 3DATE:
09/11/2025
UNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Josefina GutierrezTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Facility does not have liability insurance
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Administrator (AD) Josefina Gutierrez, discussed the purpose of the inspection, and explained the allegation.

The investigation into the allegation that facility does not have liability insurance revealed the following: During the course of the investigation, LPA inspected the facility, conducted health and safety checks on residents, interviewed AD and witnesses, and obtained and reviewed copies of the resident roster, staff roster, the facility’s Cancellation Endorsement for Policy No. 0100231885-2, and the facility’s Certificate of Liability Insurance for Policy No. PCI96398721-01.

CONTINUED
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
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 3
Control Number 22-AS-20250910084428
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: NEW ERA GUEST HOME
FACILITY NUMBER: 300613262
VISIT DATE: 09/11/2025
NARRATIVE
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It was alleged that the facility’s liability insurance lapsed due to non-payment and the facility does not have liability insurance. LPA interviewed AD who stated they stopped paying for their old insurance because the premium had gotten too high and had switched to a new insurance. LPA reviewed the facility’s Cancellation Endorsement for Policy No. 0100231885-2 which indicates the facility’s liability insurance policy was cancelled effective August 20, 2025. However, per AD, the facility obtained new insurance and now has insurance. LPA reviewed the facility’s Certificate of Liability Insurance for Policy No. PCI96398721-01 which indicates the facility has liability insurance effective September 3, 2025. LPA interviewed a witness at AD’s new insurance company who confirmed that this policy is effective September 3, 2025, and is not retroactive. Although the facility currently has liability insurance, the information obtained corroborated that the facility did not have liability insurance between August 20, 2025, and September 3, 2025.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250910084428
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NEW ERA GUEST HOME
FACILITY NUMBER: 300613262
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/12/2025
Section Cited
HSC
1569.605
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… all residential care facilities for the elderly … shall maintain liability insurance ... in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts...
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Licensee stated they have already obtained liability insurance and LPA confirmed. POC CLEARED.
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This requirement was not met as evidenced by: Based on documents and interviews, the licensee did not maintain liability insurance between August 20, 2025 and September 3, 2025, which poses an immediate personal rights risk to 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: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3