198320420-10-8-2026-11-AS-EMAZ-DYPV6Q-20261009160956

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320420
Report Date: 10/08/2026
Date Signed: 10/08/2026 02:01:50 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
09/18/2026 and conducted by Evaluator Ernand Dabuet

COMPLAINT CONTROL NUMBER: 11-AS-20260918081233

FACILITY NAME:	HAYWORTH TERRACE		FACILITY NUMBER:	198320420
ADMINISTRATOR:	CAVIN H YOO		FACILITY TYPE:	740
ADDRESS:	325 N HAYWORTH AVE		TELEPHONE:	(323) 655-3101
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	111	CENSUS: 2	DATE:	10/08/2026
		UNANNOUNCED	TIME BEGAN:	08:04 AM
MET WITH:			TIME COMPLETED:	01:27 PM

ALLEGATION(S):

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Staff did not provide residents with an eviction notice.

INVESTIGATION FINDINGS:

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On October 8, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet concluded this complaint investigation. On August 12, 2026, (CCLD) issued a Temporary Suspension Order (TSO). (TSO) temporarily suspends a facility’s license. Therefore, the Licensee Representative, Mohsen Abdosalehi, is served with this complaint investigation report through USPS Certified Mail #7018 1830 0000 6864 638.

The investigation included a records review and an observation of the facility. The Department obtained several documents, including the Personnel Report LIC 500 (dated 09/18/26), the Resident Roster (dated 09/18/26), Notice of Emergency Relocation (dated 8/17/26 and 09/18/26), (R1's) Identification and Emergency LIC 601, Admissions Agreement, and other pertinent records associated with this complaint. Interviews with Staff #1-#2 and Resident #1- #5.

(Evaluaton Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2026

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-20260918081233

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: HAYWORTH TERRACE	FACILITY NUMBER: 198320420
	VISIT DATE: 10/08/2026

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Staff did not provide residents with an eviction notice.

It is alleged that Resident #1 (R1) did not receive an eviction notice. Reports indicate that (R1) was informed that the facility’s license had been revoked and that residents must move to other facilities, without receiving any formal eviction notices. Additional reports claimed the facility was not shutting down, which created inconsistencies in the information provided.

On September 18, 2026, between 1:16 PM and 2:00 PM, the Department interviewed residents identified as Resident #1 through Resident #5 (R1-R5). Five (5) out of five (5) confirmed that they received written notices regarding relocation. Four (4) of the five (5) also reported receiving oral notices from the management team. Resident #1 (R1) stated that they received notices on August 17, 2026, and September 17, 2026, but did not consider them legitimate eviction notices.

On September 18, 2026, between 1:30 PM and 2:30 PM, the Department interviewed staff members identified as Staff #1 and Staff #2 (S1-S2). Two (2) out of the two (2) staff members confirmed that the facility had been placed on a Temporary Suspension Order due to concerns about immediate risks to residents’ health and safety, which required the facility to cease operations immediately. Accordingly, the management initiated emergency relocation procedures rather than standard eviction procedures. All residents received a “Notice of Emergency Relocation” on August 17, 2026. This notice does not conform to the 30-day, or 60-day notice requirements outlined in Title 22 Regulations.

Further review of the Notice of Emergency Relocation (dated 08/17/26 and 09/17/26) revealed that residents and/or their responsible parties received the notice in accordance with Health and Safety Code §1569.525 and the Community Care Licensing Department (CCLD) emergency relocation protocol. Interviews with residents confirmed they received relocation information from facility staff, and management indicated that eviction notices are neither legally required nor appropriate during a Department-ordered emergency closure.

Based on information gathered, there is insufficient evidence supports the allegation mentioned above.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated.

Reports sent to Licensee Representative Mohsen Abdosaleh by USPS mail and electronic mail.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2026

LIC9099 (FAS) - (06/04)

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