198320420-9-29-2026-11-AS-UCOL-DYGUS9-20261002154959

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320420
Report Date: 09/25/2026
Date Signed: 09/29/2026 03:47:58 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/30/2026 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20260630134506

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: 15	DATE:	09/25/2026
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Tim Aldanese		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff pushed a resident in care
Staff spoke to a resident in an inappropriate manner

INVESTIGATION FINDINGS:

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

On 09/25/2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Socorro Leandro concluded this complaint investigation. On 08/12/2026, (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 #70181830000068648402.

Investigation consisted of the following:

On 07/08/2026, interviews were conducted with Resident 1 (R1) to Resident 3 (R3) and Staff 1 (S1) to Staff 3 (S3). On 09/25/2026, interviews were conducted and records were reviewed. Interviews conducted consisted of Resident 4 (R4) to Resident 7 (R7) and Staff 4 (S4) to Staff 7 (S7). Interviews were attempted with Staff 8 (S8) to Staff 10 (S10). Records reviewed consisted of staff rosters, resident rosters, staff trainings, and staff records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2026

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-20260630134506

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HAYWORTH TERRACE	FACILITY NUMBER: 198320420
	VISIT DATE: 09/25/2026

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

Investigation revealed the following:

Allegation: “Staff pushed a resident in care.” Interviews conducted with R1 to R7 revealed the following: 7 out of 7 residents denied the allegation. Interviews conducted with S1 to S7 revealed the following: 4 out of 7 staff denied the allegation; 3 out of 7 staff agreed with the allegation. Observations on 07/08/2026 and 09/25/2026 revealed the following: staff were not observed pushing residents. Records reviewed of staff trainings revealed the following: staff were trained on resident personal rights. Unsubstantiated: 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.

Allegation: “Staff spoke to a resident in an inappropriate manner.” Interviews conducted with R1 to R7 revealed the following: 6 out of 7 residents denied the allegation; 1 out of 7 residents agreed with the allegation. Interviews conducted with S1 to S7 revealed the following: 4 out of 7 staff denied the allegation; 3 out of 7 staff agreed with the allegation. Observations on 07/08/2026 and 09/25/2026 revealed the following: staff were not observed talking to residents in an inappropriate manner. Records reviewed of staff trainings revealed the following: staff were trained on resident personal rights. Unsubstantiated: 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.

No deficiencies cited.

Copies of the reports were sent to Licensee Representative Mohsen Abdosaleh via USPS mail and electronic mail.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2