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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608888
Report Date: 09/18/2026
Date Signed: 09/18/2026 11:56:17 AM

Substantiated


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
09/11/2026 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20260911164431
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: 88DATE:
09/18/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Azucena ReyesTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Illegal Eviction.
INVESTIGATION FINDINGS:
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On 09/18/26 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Administrator Azucena Reyes (staff #1/S1) as the purpose of today’s visit was explained.

The investigation consisted of the following: On 09/18/26 LPA Villegas obtained copies of the staff and resident roster, and copies of the following documents for Resident #1 (R1) Facesheet, pre-appraisal, admission agreement, Physicians report dated:05/07/26, resident appraisal dated:01/28/25, Service plan report, SOC 341 report dated: 08/31/26, and medication list. On 09/18/26 from 9:30 am- 10:50 am LPA conducted Interviews with (S1), and (R1). On 09/18/26 LPA Villegas conducted a file review of docuemtns obtained.

The allegation revealed the following:
Allegation: Illegal Eviction
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2026
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-20260911164431
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: 09/18/2026
NARRATIVE
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It is alleged that Resident in care is being illegally evicted as retaliation. On 09/18/26 LPA conducted interview with R1 regarding the allegation above. R1 confirmed the allegation above and stated that the eviction notice was issued in retaliation for an incident that occurred between R1 and a peer. Furthermore, R1 stated that the facility staff is one-sided and is making R1 look like the perpetrator rather then the victim.
On 09/18/26 LPA conducted interview with S1 regarding the allegation above. S1 denied the allegation above and reported that resident in care was issued an eviction notice due to on going aggressive and physical behaviors towards female residents and towards staff. Additionally, S1 reports that S1 sent a copy of the eviction notice to CCLD for review but never heard back. On 09/18/26 LPA conducted review of the eviction notice issued to R1, CCLD obtained a copy of the eviction notice on 09/03/26. Upon review of the eviction notice it was determined that the eviction notice issued to R1 did not meet Title 22 regulations.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8) are being cited on the attached LIC 9099D.

Exit interview conducted, appeal rights provided and explained, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20260911164431
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/25/2026
Section Cited
CCR
87224(a)(2)(B-E)
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87224 Eviction Procedures The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5)...Provide each resident or the resident’s responsible person with a written notice no later than 60 days before the intended eviction. The notice shall include all of the
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Licensee/Administrator to dismiss the eviction in writing and provide a copy to resident and CCLD by POC due date. Administrator to review title 22 eviction procedures and self certify in written documents that the regulation (87224) was reviewed and it understood. Document to be sent to LPA Villegas
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following: (B)A copy of the resident’s current service plan. (C)The relocation evaluation. (D) A list of referral agencies.
(E)The right of the resident or resident’s legal representative to contact the department to investigate the reasons given for the eviction pursuant to Section 1569.35. This requirement was not met as eviction did not meet title 22 regs... eviction notice did not have an issue date or move out date, did not list CCLD contact info, no service paln attached, no referral agencies listed, or relocation eval which poses a potential health and safety risk to residents in care.


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at Lizeth.villegas@dss.ca.gov
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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.
SUPERVISOR'S NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2026
LIC9099 (FAS) - (06/04)
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