198204972-6-4-2026-11-AS-PMAA-DXKSLQ-20260903135842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204972
Report Date: 06/04/2026
Date Signed: 06/04/2026 04:04:16 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
05/07/2026 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20260507160358

FACILITY NAME:	ROSECRANS VILLA RESIDENTIAL CARE		FACILITY NUMBER:	198204972
ADMINISTRATOR:	SANDRA LOPEZ		FACILITY TYPE:	740
ADDRESS:	14110 CORDARY AVENUE		TELEPHONE:	(310) 675-9163
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY:	135	CENSUS: 109	DATE:	06/04/2026
		UNANNOUNCED	TIME BEGAN:	12:56 PM
MET WITH:	Sandra Lopez, Administrator		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Staff do not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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On 6/4/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by the Administrator, Sandra Lopez and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility.

The investigation consisted of the following:
On 5/12/26 LPA Shirley reviewed copies of the following records: Staff and Resident Roster, Certification for all Medication Technicians, Medication Administration Records (MAR’s), Assessment 4/9/26, Client/Resident Personal Property and Valuables Form LIC 621, Appraisal/Needs and Services Plan, Medical Assessment for Residential Care Facilities for the Elderly, LIC602A, Identification and Emergency Information, Admission Agreement, 8/19/25. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff- 6(S1 – S6), and Resident -1 – Resident – 10 (R1-R10).

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

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 11-AS-20260507160358

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: ROSECRANS VILLA RESIDENTIAL CARE	FACILITY NUMBER: 198204972
	VISIT DATE: 06/04/2026

NARRATIVE

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The investigation revealed the following:

Allegation: Staff do not safeguard resident's personal belongings

It is being reported that R1’s clothing are being stolen by her roommate. Upon reviewing R1’s Admission Agreement, LPA Felisa Shirley verified that the resident has been residing here since 8/19/25. On 6/4/26, LPA Shirley reviewed R1’s, Client/Resident Personal Property and Valuables form dated 8/19/25. On 6/4/26, LPA Shirley conducted a physical inventory count and compared it to R1’s inventory list; 3 items are unaccounted for. Per interview with R1 on 6/4/26, she sent items to the laundry room today. On 6/4/26, LPA Shirley went to the laundry room to tally the items sent for washing and updated R1’s inventory count. LPA escorted R1 to the laundry room on 6/4/26 to check the lost and found for her missing items, none of which were recognized as hers. Per LPA Shirley’s observation on 6/4/26, R1’s clothing is much smaller than her roommate, making it physically improbable that the roommate is taking R1’s clothing.

LPA interviewed staff 1 – staff 6 (S1 – S6). Of those interviewed 6 out of 6 denied the allegation. LPA interviewed resident 1 – resident 10 (R1 – R10). Of those who interviewed 7 out of 10 denied the allegation, 2 confirmed the allegation and 1 was not sure.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff do not safeguard resident's personal belongings,” therefore, the allegation is unsubstantiated.

No deficiencies were cited for these allegations.

An exit interview was conducted and a copy of this report was provided to the Administrator, Sandra Lopez.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

LIC9099 (FAS) - (06/04)

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