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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607907
Report Date: 09/17/2026
Date Signed: 09/17/2026 03:46:47 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2026 and conducted by Evaluator Zina Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20260909133927
FACILITY NAME:TWIN HOMECARE - BFACILITY NUMBER:
197607907
ADMINISTRATOR:ADELITA STUCHLAKFACILITY TYPE:
740
ADDRESS:2106 W. 242ND STREETTELEPHONE:
(424) 263-4849
CITY:LOMITASTATE: CAZIP CODE:
90717
CAPACITY:6; 6CENSUS: 5DATE:
09/17/2026
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:
Liza Buencillo (Caregiver)		TIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff handled resident in a rough manner.
Facility does not provide good quality food.
INVESTIGATION FINDINGS:
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On 09/17/2026 at 8:45am, Licensing Program Analyst (LPA) Zina Brown arrived at the facility to conduct an initial complaint investigation to reveal and deliver the findings. The Department spoke with Roneilio Garcia (Administrator) over the phone, and the purpose of the visit was explained.

The investigation consisted of the following: On 09/17/2026 between the hours of 9:00am - 11:39am, the Department interviewed Administrator (A1), 3 Staff (S1 - S3), 4 Residents (R2-R5), and 4 Witnesses (W1 - W4). The Department also requested and obtained documentation, which included LIC 9020 Register of Facility Clients/Residents (dated 09/01/2026), LIC 500 Personnel Report (dated 09/01/2026), R1's records such as LIC 601: Identification & Emergency Information (dated 12/31/2024), LIC 604A: Admission Agreement (dated 12/31/2024), LIC 602A: Physician's Report for RCFE (dated 06/05/2026), LIC 603 Resident Appraisal (dated 06/05/2024), LIC 625: Appraisal Needs & Service Plan (dated 06/05/2026), LIC 622 Centrally Stored Medication & Destruction Record, and the Week 4 Food Menu.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026
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
Control Number 11-AS-20260909133927
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: TWIN HOMECARE - B
FACILITY NUMBER: 197607907
VISIT DATE: 09/17/2026
NARRATIVE
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The investigation revealed the following:

Allegation: Staff handled a resident in a rough manner.
It was alleged that during a nighttime care assistance encounter, a newly assigned male caregiver entered a resident's room and physically assisted the resident in a manner that caused the resident to feel unsafe.

On 09/17/2026 between the hours of 9:00am - 9:16am, the Department interviewed Administrator (A1) regarding the allegation. A1 denied the allegation and stated being unaware that Resident 1 (R1) reported feeling unsafe with a staff member. A1 stated no investigation was conducted because the concern was never brought to their attention and reported there were no prior complaints regarding rough handling by staff.

On 09/17/2026 between the hours of 9:37am - 10:06am, the Department interviewed 3 staff regarding the allegation. 1 out of 3 staff confirmed the allegation and reported observing rough handling by a former caregiver. The staff member indicated Resident 1 (R1) experienced distress following the changes in caregivers and would compare current caregivers to former caregivers. 2 out of 3 staff denied the allegation and indicated R1 did not express concerns or discomfort while receiving care, and they did not observe staff handling R1 roughly. S1 stated R1's crying and emotional distress were due to the termination and resignation of caregivers.

On 09/17/2026 between the hours of 10:15am - 10:45am, the Department interviewed 4 residents regarding the allegation. 2 out of 4 residents denied the allegation and indicated they felt safe at the facility, had not heard of staff handling R1 roughly, and had not been handled roughly by staff themselves. 2 out of 4 residents did not confirm nor deny the allegation. R2 stated they did not believe R1 was handled roughly. However, R2 indicated from personal experience that W4 handled them badly. R4 stated they had recently moved into the facility on 09/11/2026 and did not know R1, but they had not observed or experienced staff handling residents roughly.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20260909133927
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: TWIN HOMECARE - B
FACILITY NUMBER: 197607907
VISIT DATE: 09/17/2026
NARRATIVE
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On 09/17/2026 between the hours of 11:05am - 11:39am, the Department interviewed 3 witnesses regarding the allegation. The 3 witnesses interviewed on 09/17/2026 were former employees of the facility. 2 out of 3 witnesses confirmed the allegation. W2 and W4 reported that R1 did not express concerns regarding the care they provided; however, W2 reported observing W3 handle R1 roughly. W4 further stated R1 was alert, oriented, and capable of expressing concerns regarding their care. 1 out of 3 witnesses denied the allegation. W3 stated they never handled R1 roughly and never observed R1 being handled roughly by staff. W3 reported that R1 thanked them after receiving care.

On 09/17/2026 between the hours of 1:00pm - 1:30pm, the Department conducted a records review and observed the following: There was no history or record of a LIC 624: Unusual Incident/Injury Report regarding the allegation that staff handled a resident in a rough manner.

Unsubstantiated: Based on information gathered through interviews and record reviews, there is not enough evidence to support the allegation. 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.

Allegation: Facility does not provide good quality food.
It was alleged that Resident 1 does not eat meals prepared by the facility because the food is not acceptable to the resident, resulting in the reporting party purchasing food for the resident.

On 09/17/2026 between the hours of 9:00am - 9:16am, the Department interviewed Administrator (A1) regarding the allegation. A1 denied the allegation and stated being unaware of R1 complaining about food quality, was not aware that family routinely brought food for R1, did not believe R1 regularly refused meals, and reported no complaints from other residents regarding food quality.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20260909133927
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: TWIN HOMECARE - B
FACILITY NUMBER: 197607907
VISIT DATE: 09/17/2026
NARRATIVE
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On 09/17/2026 between the hours of 9:37am - 10:06am, the Department interviewed 3 staff regarding the allegation. 1 out of 3 staff confirmed the allegation and stated R1 sometimes would not eat facility meals and reported residents occasionally complained that meals were not hot enough. 1 out of 3 staff denied the allegation and reported R1 usually ate facility meals, did not complain about the food served, the food provided was based on R1's requests, and no other residents complained about food quality. 1 out of 3 staff did not confirm nor deny the allegation and indicated R1 sometimes did not eat facility meals and food was brought by family members; however, R1 did not complain about food quality and no other residents complained.

On 09/17/2026 between the hours of 10:15am - 10:45am, the Department interviewed 4 residents regarding the allegation. 3 out of 4 residents denied the allegation. R2, R3, and R4 reported being satisfied with the meals provided by the facility, ate the meals served, and had no complaints regarding food quality. 1 out of 4 residents did not confirm nor deny the allegation and stated the food was fair but indicated some meals were better when former staff worked at the facility.

On 09/17/2026 between the hours of 11:05am - 11:39am, the Department interviewed 3 witnesses regarding the allegation. The 3 witnesses interviewed on 09/17/2026 were former employees of the facility. 1 out of 3 witnesses denied the allegation and stated they had not observed R1 refuse meals, had not heard R1 complain about the food, had not heard complaints from other residents, and had no information supporting food quality concerns. 2 out of 3 witnesses confirmed the allegation. W2 and W4 stated R1 sometimes refused facility meals and staff would occasionally purchase alternative food using their own money.

On 09/17/2026 between the hours of 1:00pm - 1:30pm, the Department conducted a records review and observed the following: According to the LIC 602A Physician's Report for RCFE (dated 06/05/2026), page 3 of 6, Item 13, Physical Health Status, is marked "Yes"; however, no information was documented in the explanation section. On the LIC 603 Resident Appraisal (dated 06/05/2026), page 2, under Services Needed, "No" is marked for special diet/observation of food intake.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20260909133927
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: TWIN HOMECARE - B
FACILITY NUMBER: 197607907
VISIT DATE: 09/17/2026
NARRATIVE
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The facility maintained a written weekly menu (Week 4) identifying planned breakfast, lunch, dinner, and snack items for each day of the week. The menu reflected a variety of food options, including oatmeal, eggs, fruit, soup, sandwiches, chicken, turkey, pork, vegetables, salads, rice, potatoes, desserts, and snacks. The menu also identified designated meal and snack times.

Unsubstantiated: Based on information gathered through interviews and record reviews, there is not enough evidence to support the allegation. 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 Liza Buencillo (Caregiver) and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5