198204972-9-9-2026-11-AS-UCOL-DYP28B-20261008171005

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204972
Report Date: 09/09/2026
Date Signed: 09/09/2026 04:06:10 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
09/03/2026 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20260903113744

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: 110	DATE:	09/09/2026
		UNANNOUNCED	TIME BEGAN:	10:23 AM
MET WITH:	Sandra Lopez, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not ensure residents personal belongings were kept safely secured

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 9/9/26, 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 9/9/26 LPA Shirley reviewed copies of the following records: Staff and Resident Roster, Identification and Emergency Contact, Physicians Report, Appraisal/Needs and Services, SSG Out-Patient Visit Documents, Laundry Schedule, Log of laundry bags for residents, Record of Residents Safeguarded Cash Resources, and Resident Personal Property and Valuables. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff 5 (S1 – S5), and Resident 1 – Resident 6 (R1-R6).

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026

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 2

Control Number 11-AS-20260903113744

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: 09/09/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:

Allegation: Staff did not ensure residents’ personal belongings were kept safely secured

It is being alleged that facility staff lost R1’s bag of laundry and the resident only had the clothes that they were wearing. On 9/9/26 LPA Felisa Shirley reviewed the facility’s laundry schedule and observed R1’s name indicating that their laundry day is on Mondays. LPA Shirley also reviewed R1’s personal property and valuables list dated 2/28/25, which documented numerous personal items and clothing. The personal property list also included dates 1/23/25 and 1/23/26, on which additional personal items were documented. On 9/9/26, LPA Shirley reviewed R1’s out-patient visit documents stating that R1 was hospitalized from 8/12/26 due to increased agitation and delusional thought content. Outpatient documentation indicated that R1 was diagnosed with a urinary tract infection (UTI) on 8/28/26. On 9/9/26, LPA went to R1’s room and observed numerous articles of clothing on R1’s side of the closet, as well as a black garbage bag in the corner labeled with R1’s name. The bag contained a small amount of clothing. LPA Shirley also observed that some of the clothing items hanging in the resident’s side of the closet had R1’s name written inside of them.

LPA interviewed staff 1 – staff 5 (S1 – S5). Of those interviewed 5 out of 5 denied the allegation. LPA interviewed resident 1 – resident 6 (R1 – R6). Of those who interviewed 4 out of 6 denied the allegation and 2 confirmed it.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not ensure residents personal belongings were kept safely secured,” 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: 09/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2