198603218-8-13-2026-28-AS-LHIS-DY2NPU-20260918103851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603218
Report Date: 08/13/2026
Date Signed: 08/13/2026 01:38:13 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/07/2026 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260807164958

FACILITY NAME:	FIL-AM HOME FOR SENIORS III		FACILITY NUMBER:	198603218
ADMINISTRATOR:	MICLAT, TOBY		FACILITY TYPE:	740
ADDRESS:	380 W BASELINE RD		TELEPHONE:	(714) 408-8996
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	6	CENSUS: 6	DATE:	08/13/2026
		UNANNOUNCED	TIME BEGAN:	09:21 AM
MET WITH:	House Manager Claudia Orozco		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff do not ensure resident is bathed.
Staff do not meet resident's incontinence care needs.
Staff do not reposition resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 08/13/2026 regarding the above allegations. During today’s visit LPA Ramirez was greeted by House Manager Claudia Orozco and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff#1 - 4 interviews (S1 – S4), Resident#1- 5 interviews (R1- R5), attempted interview with resident#6 (R6), observation notes, physician’s report, Medication Administration Record (MAR), Resident Appraisal for Resident#1 (R1), and physical plant tour.

See 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026

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 28-AS-20260807164958

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: FIL-AM HOME FOR SENIORS III	FACILITY NUMBER: 198603218
	VISIT DATE: 08/13/2026

NARRATIVE

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The investigation revealed the following: regarding the allegation “Staff do not ensure resident is bathed.” It is alleged that staff did not bathe R1 for several weeks. Four (4) out of the four (4) staff interviewed denied this allegation. Staff interviewed revealed that R1 is given bed baths every other day. Staff revealed that due to R1’s limited mobility and diagnosis, it is unsafe to move R1 into a shower chair. Staff revealed they document when all residents get bathed. During record review, LPA observed staffing notes that indicated R1 was provided bed baths regularly. Five (5) out of the five (5) residents interviewed denied this allegation. Residents interviewed revealed that staff assist them with bathing on a regular basis. R6 was unavailable to be interviewed during LPA’s visit. During tour of the facility LPA observed residents to be well groomed and did not observe residents to malodorous. 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.

“Staff do not meet resident's incontinence care needs.” It is alleged that staff are not meeting R1’s incontinence care needs. Four (4) out of the four (4) staff interviewed denied this allegation. Staff interviewed revealed that any residents that require assistance with toileting and incontinence, are assisted and changed at least every 2 hours. During record review, LPA observed staffing notes that indicated R1 is provided incontinence care on a regular basis. Five (5) out of the five (5) residents interviewed denied this allegation. Residents interviewed revealed staff assist them with toileting and changing their incontinence briefs. During tour of the facility LPA observed residents to be well groomed and did not observe residents to malodorous. 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.

“Staff do not reposition resident.” It is alleged that staff do not reposition R1. Four (4) out of the four (4) staff interviewed denied this allegation. Staff interviewed revealed that R1 is checked at least every 2 hours and always reposition every 2 hours. Staff revealed that they make attempts to bring R1 into the living room but R1 declines to be moved due to pain R1 experiences when they are moved. Five (5) out of the five (5) residents interviewed denied this allegation. Interview with R1 revealed that they don’t want to be moved too much due to pain in their lower back when moved out of their bed. R1 revealed staff does reposition them often. 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.

Exit interview was conducted. A copy of this report was provided. No deficiencies were cited for this complaint investigation.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2026

LIC9099 (FAS) - (06/04)

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