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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320009
Report Date: 08/18/2026
Date Signed: 08/18/2026 03:39:50 PM

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
08/13/2026 and conducted by Evaluator Jose Anguiano
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20260813124843
FACILITY NAME:WELLNESS WORLD LLCFACILITY NUMBER:
198320009
ADMINISTRATOR:GOMEZ, ELIZABETH CFACILITY TYPE:
740
ADDRESS:1119 E 215TH PLTELEPHONE:
(213) 568-7298
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY:6CENSUS: 6DATE:
08/18/2026
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Elizabeth GomezTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff does not ensure that resident is able to receive services of their choice
INVESTIGATION FINDINGS:
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On 08/18/2026, at approximately 9:00AM, Licensing Program Analyst (LPA) Jose Anguiano conducted an unannounced complaint visit. LPA met with Administrator Elizabeth Gomez and explained the purpose of today’s visit.
The investigation consisted of the following:

On 08/17/26, around 3:00PM, the Department conducted an interview with witness (W1). On 08/18/26, around 9:00AM, The Department conducted interviews with six residents (R1–R6) and Administrator Elizabeth Gomez (A1). The Department obtained and reviewed R1’s signed and initialed enhanced care consent & acknowledgement Form dated 08/06/26; written communication from A1 to the service provider dated 08/11/26 at 10:51AM, R1’s Facility Admission Agreement dated 06/20/26; and R1’s Medical Assessment dated 06/25/26.
Please see report continuation on (LIC9099-C).
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026
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-20260813124843
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: WELLNESS WORLD LLC
FACILITY NUMBER: 198320009
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/25/2026
Section Cited
CCR
87468.1(a)(16)
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Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (16) To receive or reject medical care or other services.
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The Administrator agreed to submit a written plan explaining how the facility will protect residents’ rights and follow licensing requirements and send to LPA at Jose.Anguiano@dss.ca.gov
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This requirement is not met as evidenced by: Interviews and records confirmed that R1 consented to receive enhanced care services and did not request cancellation. A1’s interview and written communication confirmed that A1 requested the service provider cancel and void the information and signatures obtained from R1. This violation poses/posed an immediate health, safety, or personal rights risk to persons in care.
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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: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20260813124843
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: WELLNESS WORLD LLC
FACILITY NUMBER: 198320009
VISIT DATE: 08/18/2026
NARRATIVE
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The investigation revealed the following: Regarding the allegation, “Staff does not ensure that resident is able to receive services of their choice,” it is alleged that facility staff interfered with R1’s choice to receive enhanced care services. Observations conducted revealed the following: During the interview, the Department observed R1 participate in the interview and responded directly and consistently to questions regarding R1’s decision to receive enhanced care services. Interviews conducted revealed the following: The Department conducted interviews with six residents (R1–R6). Interview with R1 confirmed that R1 wanted enhanced care services and did not ask anyone to cancel the services. Of the remaining five residents, R3 and R4 disagreed with the allegation and did not provide further details and (R2, R5, and R6) were unable to provide relevant information due to observed cognitive and health-related limitations. Interview with A1 confirmed that A1 contacted the enhanced care service provider and requested that R1’s services and related documents be cancelled and voided. A1 stated having concerns regarding how R1’s consent was obtained and believed the process was not transparent. W1 stated that A1 requested cancellation of R1’s services rather than R1 requesting cancellation. Records reviewed revealed the following: Records reviewed confirmed that R1 signed and initialed the enhanced care service provider consent form dated 08/06/26, documenting R1’s consent & acknowledgement to receive enhanced care services. Written communication from A1 to the service provider dated 08/11/26 at 10:51AM, confirmed that A1 requested that the information and signatures obtained from R1 be cancelled and voided. R1’s Facility Admission Agreement dated 06/20/26 identified R1 as responsible for self. R1’s Medical Assessment dated 06/25/26 did not identify cognitive condition.
Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED. This is a violation of California Code of Regulations, Title 22, Division 6, Chapter 8. A citation is being issued on the attached LIC-9099D.

An exit interview, a copy of this report, and appeal rights were provided to the Administrator.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3