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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 07/30/2026
Date Signed: 07/30/2026 04:41:54 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
07/23/2026 and conducted by Evaluator Jose Anguiano
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20260723083501
FACILITY NAME:WEST PICO TERRACE ASSISTED LIVING CENTER LPFACILITY NUMBER:
197608888
ADMINISTRATOR:AZUCENA REYES SERRANOFACILITY TYPE:
740
ADDRESS:6050 W PICO BLVDTELEPHONE:
(323) 653-5565
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:136CENSUS: 87DATE:
07/30/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Azucena ReyesTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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9
Staff did not allow the resident to leave the facility
Staff did not ensure that the resident's dental care needs were met
Staff did not provide proper food service to resident in care
INVESTIGATION FINDINGS:
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On 07/30/2026 around 9:00AM, Licensing Program Analyst (LPA) Jose Anguiano conducted an unannounced complaint visit. LPA met with the Administrator Azucena Reyes.

The investigation consisted of the following: The Department interviewed 10 Residents (R1–R10) and four staff members (S1-S5). The following records were collected: Resident roster dated 07/30/2026, staff roster, two complete resident files and two face sheets.

The investigation revealed the following: Regarding the allegation “Staff did not allow the resident to leave the facility” It is being alleged that R1 wanted to go home and was not allowed or provided transportation or escorting to go home. Interviews revealed the following: Nine out of ten residents (R1–R7, R9–R10) disagreed with the allegation.
Please see (LIC9099-C) for report continuation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
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 3
Control Number 11-AS-20260723083501
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: WEST PICO TERRACE ASSISTED LIVING CENTER LP
FACILITY NUMBER: 197608888
VISIT DATE: 07/30/2026
NARRATIVE
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Based on the evidence gathered, interviews conducted, observations, and records reviewed, although the allegation “Staff did not provide proper food service to resident in care” 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.
An exit interview was conducted, and a copy of this Complaint Report was given to the Administrator.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20260723083501
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: WEST PICO TERRACE ASSISTED LIVING CENTER LP
FACILITY NUMBER: 197608888
VISIT DATE: 07/30/2026
NARRATIVE
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3
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5 out of 5 staff disagreed with the allegation (S1-S5). Staff (S5) stated that the facility arranged transportation for R1 to return home, as well as at least three additional trips. S5 further stated that on one occasion, R1 declined an arranged trip. Records review revealed the following: Physician’s Report dated 07/24/2025 indicates (R1) is unable to leave the facility unassisted due to mental and physical condition. Preplacement Appraisal dated 09/24/2025 states R1 is not functionally capable of using a walker or leaving/entering the facility unassisted. Facility Acknowledgement record dated 07/29/26 at 12:45 PM documents that R1 voluntarily left the facility against recommendation, accepted responsibility while away, and agreed to arrange their own transportation unless otherwise coordinated. Based on the evidence gathered, interviews conducted and records reviewed, although the allegation “Staff did not allow the resident to leave the facility 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.

Regarding the allegation “Staff did not ensure that the resident's dental care needs were met”. Interviews conducted revealed the following: 9 out of 10 residents disagreed with the allegation (R2-R10), while 1 out of 10 agreed with the allegation (R1). (R1) admitted to being seen by dentist provided by the facility and not agreeing with their assessment. 5 out of 5 staff (S1-S5) disagreed with the allegation. (S5) stated that (R1) was seen for an annual dental exam on 11/10/2025 additionally refused dental services on 05/28/2026. Records review revealed the following: Facilities Dental visit summary record dated 05/28/2026 indicates (R1) refusing services recommended by dentist. Based on the evidence gathered, interviews conducted, observations, and records reviewed, although the allegation “Staff did not ensure that the resident's dental care needs were met” 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.

Regarding the allegation Staff did not provide proper food service to residents in care: It is being alleged that staff is not providing the quality diet resident needs due to medical condition. Interviews conducted revealed the following: 1 out of 10 residents disagreed with the allegation (R1). While 9 out of 10 disagreed (R2-R10). (S1) indicated that they have been following physicians’ orders for (R1) regarding diet. Records review revealed the following: Pre-Placement Appraisal dated 09/24/2025 notes (R1) require a RENAL DIET (“RENAL” under Special Diet), which is a kidney friendly plan limiting sodium, potassium, and phosphorus (and sometimes protein or fluids). Ref: Institute of Health.
Please see (LIC9099-C) for report continuation.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3