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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608604
Report Date: 03/10/2026
Date Signed: 06/16/2026 10:12:05 AM

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
03/02/2026 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260302154316
FACILITY NAME:PROMISE ASSISTED LIVING, LLC.FACILITY NUMBER:
197608604
ADMINISTRATOR:GREGORY Z. RESTUMFACILITY TYPE:
740
ADDRESS:1231 SOUTH ALVARADO STREETTELEPHONE:
(310) 205-2591
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY:22CENSUS: 22DATE:
03/10/2026
UNANNOUNCEDTIME BEGAN:
10:27 AM
MET WITH:Roxanne Aparicio - SupervisorTIME COMPLETED:
03:34 PM
ALLEGATION(S):
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Staff does not ensure the facility is kept free of pests
Licensee does not ensure all the staff can adequately communicate with residents
Staff don't ensure residents room is kept clean and sanitary at all times
Staff do not ensure residents receive their mail correspondence
INVESTIGATION FINDINGS:
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***This is an ammended report of original report dated 3/10/2026. The reason it is being ammended is to remove confidential information from the original report.***

Licensing Program Analyst (LPA) Erik Zaragoza conducted an initial unannounced complaint visit to address the allegations listed above. LPA met with Roxanne Aparicio, supervisor for the facility, and explained the purpose of the visit. Administrator Gregory Restum was notified of the visit by phone call.

The investigation consisted of the following: LPA obtained a copy of the staff and resident rosters, conducted a tour of the facility including resident bedrooms, interviewed Residents #1 - 7 (R1 - R7), Staff #1 - 5 (S1 - S5), and also obtained the physician's report and appraisal of R1.

The investigation revealed the following: In regards to the allegation that "Staff does not ensure the facility is kept free of pests," it is alleged that bed bugs, roaches, and spiders have been present inside the resident bedrooms and that staff are not addressing the issue.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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 6
Control Number 28-AS-20260302154316
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: PROMISE ASSISTED LIVING, LLC.
FACILITY NUMBER: 197608604
VISIT DATE: 03/10/2026
NARRATIVE
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Based on interviews with the residents, five (5) out of seven (7) did not corroborate the allegation. One of the residents interviewed stated that there have been bedbugs and roaches present in their room in the past, however the staff are treating them with a pest control company. Another resident interviewed stated that they have not had any problems with bedbugs or other pests in their room. During interviews with the staff, none of them corroborated the allegation. One staff interviewed stated that they do receive services from a pest control company to treat and prevent bedbugs. Another staff member interviewed also stated that pest control frequently come to perform treatment for bedbugs and roaches. During record review of the last invoice from the facility's pest control company dated 3/5/2026, it is detailed that all rooms were treated for bedbugs.

In regards to the allegation that "Licensee does not ensure all the staff can adequately communicate with residents," it is alleged that S6 has difficulty communicating with residents by speaking too quickly and in Spanish. During interviews with the residents, five (5) out of seven (7) did not corroborate the allegation. One of the residents interviewed stated that S6 does their best to assist residents to the best of their ability despite a language barrier. Another resident stated that all staff communicate with them effectively and treat them with dignity and respect. During interviews with the staff, none of them corroborated the allegation. One of the staff interviewed stated that S6 does not have bad communication with the residents and is able to assist them with their daily needs. Another staff interviewed also stated S6 communicates effectively with the residents of the home. All staff present during the visit were capable of speaking English and did not have difficulties communicating with the residents.

In regards to the allegation that "Staff don't ensure residents room is kept clean and sanitary at all times," it is alleged that staff are not cleaning resident bedrooms and are allowing trash to accumulate in their bedrooms. During interviews with the residents, six (6) out of seven (7) did not corroborate the allegation. One resident interviewed stated that staff clean their room all the time and they never leave it dirty. Another resident interviewed stated that their room is cleaned twice per day and this is not an issue. During interviews with the staff, none of them corroborated the allegation. One of the staff interviewed stated that staff do ensure that they clean resident bedrooms and do not refuse to clean any resident room. Another staff member also stated that staff ensure to clean resident rooms multiple times per day. During a tour of the resident bedrooms, LPA observed that all rooms were cleaned and there was no trash overflowing in any of the resident bedrooms.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20260302154316
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: PROMISE ASSISTED LIVING, LLC.
FACILITY NUMBER: 197608604
VISIT DATE: 03/10/2026
NARRATIVE
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In regards to the allegation that "Staff do not ensure residents receive their mail correspondence," it is alleged that staff are opening residents mail before deliver it to them and also deliberately refusing to provide residents their mail. Based on interviews with the residents, six (6) out of seven (7) did not corroborate the allegation. One resident interviewed stated that this never occurs and they always receive their mail unopened. Another resident also stated they have not had any issues with having their mail opened by staff. During interviews with the staff, none of them corroborated the allegation. One staff interviewed stated that the mail box is locked so that only the owner of the facility can open it, and once it is opened they distribute all mail to residents unopened. Another staff member stated that they do not open the residents' mail and always hand it directly to the residents after they receive it. LPA observed the mailbox for the facility locked at the time of the visit.

Based on statements and interviews conducted with staff/residents, review of facility file records, and LPA's observations, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
03/02/2026 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260302154316

FACILITY NAME:PROMISE ASSISTED LIVING, LLC.FACILITY NUMBER:
197608604
ADMINISTRATOR:GREGORY Z. RESTUMFACILITY TYPE:
740
ADDRESS:1231 SOUTH ALVARADO STREETTELEPHONE:
(310) 205-2591
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY:22CENSUS: 22DATE:
03/10/2026
UNANNOUNCEDTIME BEGAN:
10:27 AM
MET WITH:Roxanne Aparicio - SupervisorTIME COMPLETED:
03:34 PM
ALLEGATION(S):
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Licensee does not ensure injections are administered by an appropriately skilled professional for residents in care
INVESTIGATION FINDINGS:
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5
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Licensing Program Analyst (LPA) Erik Zaragoza conducted an initial unannounced complaint visit to address the allegation listed above. LPA met with Roxanne Aparicio, supervisor for the facility, and explained the purpose of the visit. Administrator Gregory Restum was notified of the visit by phone call.

The investigation consisted of the following: LPA obtained a copy of the staff and resident rosters, conducted a tour of the facility including resident bedrooms, interviewed Residents #1 - 7 (R1 - R7), Staff #1 - 5 (S1 - S5), and also obtained the physician's report and appraisal of R1.

The investigation revealed the following: In regards to the allegation that "Licensee does not ensure injections are administered by an appropriately skilled professional for residents in care," it is alleged that staff that are administering insulin to residents are not medically trained professionals, which led to a staff member causing a resident pain when administering their insulin.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20260302154316
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: PROMISE ASSISTED LIVING, LLC.
FACILITY NUMBER: 197608604
VISIT DATE: 03/10/2026
NARRATIVE
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During interviews with the residents, three (3) out of seven (7) corroborated the allegation. All three (3) residents interviewed who require insulin stated that staff have assisted them with their insulin injections. One of the residents stated that the majority of the time staff inject their insulin for them, and that they believe they are doing it effectively. During interviews with the staff, four (4) out of five (5) corroborated the allegation. One of the caregivers interviewed stated that they assist some residents with their insulin injections directly, and that they are not a registered nurse or licensed vocational nurse. Another caregiver interviewed also corroborated that they assist residents by administering their insulin injections. According to Title 22 regulations, residents of residential care facilities for the elderly (RCFEs) must either administer insulin themselves, or must be assisted by an appropriately skilled professional.

Based on LPAs observations and interviews which were conducted , the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 is being cited on the attached LIC9099D. Exit interview held, and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20260302154316
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: PROMISE ASSISTED LIVING, LLC.
FACILITY NUMBER: 197608604
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/11/2026
Section Cited
CCR
87629(a)
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(a) The licensee shall be permitted to accept or retain a resident who requires intramuscular, subcutaneous, or intradermal injections if the injections are administered by the resident or by an appropriately skilled professional.
This regulation is not met as evidenced by:
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Licensee/Administrator is to ensure that insulin injections are performed either by the residents themselves or a an appropriately skilled professional at all times. Administrator is to submit the facility's plan to LPA by email on how this requirement will be met by the POC due date.
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Based on interviews, LPA determined that the facility did not meet the above requirement in three (3) out of twenty-two (22) residents, as staff and resident interviews revealed caregivers are assisting R1, R2, and R3 with insulin injections, which poses an immediate health and safety risk to residents.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6