198603727-7-21-2026-28-AS-DSIS-DY8S6P-20260924133613

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603727
Report Date: 07/21/2026
Date Signed: 07/21/2026 02:31:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
07/13/2026 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260713145056

FACILITY NAME:	NORWALK VILLAS I		FACILITY NUMBER:	198603727
ADMINISTRATOR:	WOOD, CHERIE		FACILITY TYPE:	740
ADDRESS:	12121 164TH ST		TELEPHONE:	(562) 229-9957
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	6	CENSUS: 6	DATE:	07/21/2026
		UNANNOUNCED	TIME BEGAN:	09:51 AM
MET WITH:	S2 - Caregiver		TIME COMPLETED:	02:37 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff retaliating against resident.
Staff did not provide resident with a 30-days notice.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced complaint visit to address the allegations listed above. LPA met with S2, caregiver for the facility, and explained the purpose of the visit. Administrator Cherie wood arrived shortly therefater.

The investigation consisted of the following: LPA interviewed Residents #1 - 3 (R1 - R5), Staff #1 - 3 (S1 - S3), and also obtained the 30-day eviction notice, physician's report, admissions agreement, and Serious Incident Report (SIR) dated 6/2/2026 for R1. LPA attempted to interview Resident #6 (R6), however they were asleep during the visit.

The investigation consisted of the following: In regards to the allegation "Staff retaliating against resident," it is alleged that staff retaliated against R1 for filing a complaint by threatening eviction.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

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-20260713145056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: NORWALK VILLAS I	FACILITY NUMBER: 198603727
	VISIT DATE: 07/21/2026

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

During interviews with the residents, three (3) out of five (5) did not corroborate the allegation. One resident interviewed stated that they have never experienced retaliation by any staff member. Another resident interviewed stated that they have not seen residents being retaliated against by staff, and that all staff treat everyone with dignity and respect. During interviews with the staff members, none of them corroborated the allegation. One staff member interviewed stated that they have not been retaliating against any of the residents in the home. Another staff member stated that none of the staff have been retaliating against any of the residents for any reason. During the tour of the facility, LPA did not observe any residents to be retaliated against during the visit.

In regards to the allegation "Staff did not provide resident with a 30-days notice," it is alleged that staff did not provide R1 a 30-day eviction notice. During interviews with the residents, four (4) out of five (5) interviewed did not corroborate the allegation. One resident interviewed stated that they had no knowledge of any resident being issued a 30-day eviction notice. Another resident overheard that a resident was being evicted from the facility, but was not fully aware of what was occurring. During interviews with the staff, none of them corroborated the allegation. S1 stated that they attempted to give the 30-day eviction notice to R1 on 6/1/2026, however R1 refused to accept the 30-day eviction notice. S2 stated that they were present at the time R1 was given the 30-day eviction and that R1 refused. The 30-day eviction notice indicates that R1 is being evicted due to non-payment of the rate for basic services within ten (10) days of the due date of $1,398.07 for the previous twenty-two (22) months. The SIR dated 6/2/2026 indicates that S1, S2, and Staff #4 (S4) were present at the time of the eviction.

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 allegations are Unsubstantiated. Exit interview held and a copy of the report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2