197802563-8-20-2026-28-AS-FFIS-DXHV78-20260901161041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197802563
Report Date: 08/20/2026
Date Signed: 08/20/2026 01:34:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
05/18/2026 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260518121219

FACILITY NAME:	EL DESCANSO RETIREMENT HOME		FACILITY NUMBER:	197802563
ADMINISTRATOR:	BOUSHERI, CLEMENCIA		FACILITY TYPE:	740
ADDRESS:	21020 E. CIENEGA AVENUE		TELEPHONE:	(626) 967-2868
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	15	CENSUS: 12	DATE:	08/20/2026
		UNANNOUNCED	TIME BEGAN:	08:12 AM
MET WITH:	Administrator, Clemencia Bousheri		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff took videos of residents without consent
Staff did not intervene when outside vendor took videos and pictures of residents without consent

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vaid conducted a subsequential visit for the above-mentioned allegations and was allowed entry by Caregiver, Norma Salazar. Facility manager, Escarling Godoy arrived shortly after, and the reason for the visit was discussed. Obtained staff and residents' rosters. LPA Vaid and Manager Godoy toured the facility and did not observe any health and safety concerns.

On 05/26/2026, LPA Vaid conducted initial visit and requested, obtained and reviewed the following documents: staff roster, resident roster, R1-face-sheet, admissions agreement, photo release and confidentiality agreement. Interviewed staff, residents and witnesses.

Regarding the allegation: Staff took videos of residents without consent. It is alleged that the staff took videos of residents without their consent. Three of three staff deny this, facility does not consent to the residents or resident's representatives use of recording equipment in the facility, the only exception is when informed consent and full knowledge is applied, residents' representatives can utilize the facility patio areas to record private parties.
CONTINUED ON 9099C.......

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260518121219

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: EL DESCANSO RETIREMENT HOME	FACILITY NUMBER: 197802563
	VISIT DATE: 08/20/2026

NARRATIVE

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In November of 2025, R1's family held a party for R1 and hired Entertainer/Videographer Polly Wolly for R1's birthday celebration and to video record the event. In the video recordings, the people identified by staff and witnesses are not residents of the facility, they are R1's family members who agreed to be video recorded and participated with holding the recording device. The facility staff did not take videos of R1. The facility staff did not hire the entertainer, the family of R1 hired the videographer. Fifteen of fifteen residents interviewed could not corroborate this, residents are not aware of this incident happening. W2 family of R1 acknowledge hiring the entertainer but were not aware of the content of the videos posted. Based on records reviewed and interviews conducted, 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.

Regarding the allegation: Staff did not intervene when outside vendor took videos and pictures of residents without consent. It is alleged that the facility staff did not stop outsider vendor from taking pictures and videos of the residents without their consent. Three of three staff deny this, according to S1 the entertainment company was not hired by the facility. The entertainment company was hired by R1’s family and R1’s family sought facility permission to hold the party in the patio area of the facility. According to W2 and W3, all the people shown in the videos were R1 and R1’s family and no other resident or staff. W2 stated having hired the entertainer for R1’s birthday party and was not aware of the content posted on internet platforms. Therefore, the facility staff are not responsible for video and pictures taken of R1 and R1’s family by an outside vendor approved by R1 and their family. Therefore, based on interviews, review of videos and pictures with staff and witnesses, 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.

An exit interview was conducted and copy of this report was provided to Administrator Clemencia Bousheri.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

LIC9099 (FAS) - (06/04)

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