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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320420
Report Date: 05/28/2026
Date Signed: 05/28/2026 05:03:33 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/19/2026 and conducted by Evaluator Regina Cloyd
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20260519100831
FACILITY NAME:HAYWORTH TERRACEFACILITY NUMBER:
198320420
ADMINISTRATOR:CAVIN H YOOFACILITY TYPE:
740
ADDRESS:325 N HAYWORTH AVETELEPHONE:
(323) 655-3101
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY:111CENSUS: 51DATE:
05/28/2026
UNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Cavin YooTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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9
Staff did not prevent resident from harming themselves.
Staff did not provide a blanket to resident in care.
Staff spoke inappropriately to resident in care.
INVESTIGATION FINDINGS:
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On 05/28/26, Licensing Program Analyst (LPA) Regina Cloyd conducted an initial visit to gather information regarding the above allegations. LPA met with Administrator Cavin Yoo.

Investigation consisted of the following: On 05/28/26, the Department obtained Register of Residents, Personnel Report (05/27/26), Unusual Incident Report (05/14/26), and Resident #1’s Record. LPA interviewed Residents #1 - #6 (R1 – R6) and Staff #1 - #4 (S1 – S4). LPA left a voicemail for Staff #5 - #6. Note: R1 is no longer at the facility.

Investigation revealed the following:
Allegation: Staff did not prevent resident from harming themselves.
It is alleged staff neglected Resident #1 (R1) and did not prevent R1 from harming self.
Record review of R1’s medical assessment (05/05/26) revealed R1 displays expressions of frustration and does not have suicidal ideation. Continue to LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
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 3
Control Number 11-AS-20260519100831
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HAYWORTH TERRACE
FACILITY NUMBER: 198320420
VISIT DATE: 05/28/2026
NARRATIVE
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Review of Unusual Incident Report (05/14/26) revealed R1 acted aggressively towards the caregivers and started hurting self; thus, emergency services were called. Four out of four staff interviews (S1 – S4) indicated staff conduct rounds at least every two hours. S1 indicated staff checked on R1 often because R1 was screaming and staff went to check on R1. S3 indicated R1 had some bleeding that could have been treated with first aid but R1 would not allow staff to treat R1. S3 indicated R1 was aggressive with staff, used a cane as a weapon to keep staff away, and was commenting on suicide. Therefore, S3 called emergency services. S4 indicated R1 was aggressive and hitting people. Four out of five resident interviews (R2 – R6) indicated their care needs are met.

Regarding the allegation, “Staff did not prevent resident from harming themselves,” based on record reviews and interviews, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

Allegation: Staff did not provide a blanket to resident in care.
Four out of six resident interviews (R1 – R6) indicated that have enough blankets to stay warm. Four out of four staff interviews (S1 – S4) indicated residents are provided with blankets. S1 and S3 – S4 indicated R1 had a blanket. S3 indicated R1 was throwing all of the blankets and trying to destroy all of the closet items. S4 indicated the room has heating. S2 showed the LPA multiple blankets in the residents’ closets.

Regarding the allegation, “Staff did not provide a blanket to resident in care,” based on interviews and observations, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

Continue to LIC9099-C.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20260519100831
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HAYWORTH TERRACE
FACILITY NUMBER: 198320420
VISIT DATE: 05/28/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
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15
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Allegation: Staff spoke inappropriately to resident in care.
Four out of six resident interviews (R1 – R6) indicated staff has not spoken to them inappropriately. Four out of four staff interviews (S1 – S4) indicated staff has not spoken to the residents inappropriately.

Regarding the allegation, “Staff spoke inappropriately to resident in care,” based on interviews, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

An exit interview was conducted and a hard copy of this report was provided to Cavin Yoo.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3