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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603550
Report Date: 06/26/2026
Date Signed: 06/26/2026 12:12:18 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
06/04/2026 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260604012005
FACILITY NAME:WEST PARK SENIOR LIVINGFACILITY NUMBER:
198603550
ADMINISTRATOR:JERI MILESFACILITY TYPE:
740
ADDRESS:801 CYPRESS WAYTELEPHONE:
(909) 592-8844
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:200CENSUS: 120DATE:
06/26/2026
UNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Administrator Jeri MilesTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff did not provide a safe environment for residents in care.
Staff did not report an incident in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 06/26/2026 regarding the above allegation. On 06/05/2026, LPA Ramirez conducted an initial complaint investigation visit and a need for further investigation was documented. During today’s visit LPA Ramirez was greeted by Administrator Jeri Miles and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Staff#1 - 2 interviews (S1 – S2), Resident#1-10 interviews (R1- R10), Copies of staff and resident written statements, Copies of email correspondence, Copies of Unusual Incident/Injury Report, Copy of resident#2 (R2) admission agreement and Emergency Identification Information, 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: 06/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026
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 28-AS-20260604012005
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: WEST PARK SENIOR LIVING
FACILITY NUMBER: 198603550
VISIT DATE: 06/26/2026
NARRATIVE
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The investigation revealed the following: regarding the allegation “Staff did not provide a safe environment for residents in care” It is alleged that staff are not providing a safe environment for residents in care. Review of Unusual Incident/Injury Report dated 05/29/2026, revealed that on 05/28/2026 at approximately 3pm, several residents were playing blackjack in the facility ballroom. R1 and R2 were seated next to each other when R2 stated “Hit me” referring to R2 wanting another card. R1 then said “okay” and hit R2 on their upper arm. R2 told R1 “do not do that” and R1 replied “I was just playing.” The game continued with no further issues. Staff later assessed R2 for pain or injuries. No visible marks or bruises were noted and R2 did not complain about pain. Review of resident statements who were present during the incident on 05/28/2026, did not corroborate the allegation. Review of written staff statement regarding the incident on 05/28/2026 did not corroborate the allegation. Two (2) out of the two (2) staff interviewed denied the allegation. Staff interviews revealed that law enforcement arrived to interview R1 and R2. Law enforcement left facility without incident and it was revealed no further investigation would be warranted. Nine (9) out of ten (10) residents interviewed did not corroborate the allegation. Nine (9) out of the ten (10) residents interviewed revealed they feel “safe” at the facility. 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 did not report an incident in a timely manner” It is alleged that staff did not report an incident in a timely manner. Two (2) out of the two (2) staff interviewed denied the allegation. Nine (9) out of ten (10) residents interviewed did not corroborate the allegation. Review of Unusual Incident/Injury Report dated 05/29/2026, revealed that on 05/28/2026 at approximately 3pm, several residents were playing blackjack in the facility ballroom. R1 and R2 were seated next to each other when R2 stated “Hit me” referring to R2 wanting another card. R1 then said “okay” and hit R2 on their upper arm. R2 told R1 “do not do that” and R1 replied “I was just playing.” The game continued with no further issues. Staff later assessed R2 for pain or injuries. No visible marks or bruises were noted and R2 did not complain about pain. Review of this incident report revealed that the facility reported this incident via fax to this licensing agency on 05/29/2026. Record review of R2’s admission agreement dated 2024, revealed that R2 is self- responsible. 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 were cited. Exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026
LIC9099 (FAS) - (06/04)
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