198602190-5-6-2026-11-AS-UCOL-DUUPPE-20260608112922

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602190
Report Date: 05/06/2026
Date Signed: 05/06/2026 02:28:30 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
04/28/2026 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20260428084903

FACILITY NAME:	CASA DEL SOL RESIDENCE		FACILITY NUMBER:	198602190
ADMINISTRATOR:	JACOBS, DOV E		FACILITY TYPE:	740
ADDRESS:	11606 11602 W WASHINGTON BLVD		TELEPHONE:	(323) 678-4426
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90066
CAPACITY:	12	CENSUS: 6	DATE:	05/06/2026
		UNANNOUNCED	TIME BEGAN:	10:03 AM
MET WITH:	STAFF VALERIE HANSON		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff mismanages resident's medication
Staff speaks inappropriately to resident

INVESTIGATION FINDINGS:

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

On 05/06/2026 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Casa Del Sol Residence and was greeted by Staff Valerie Hanson (S1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
The investigation consisted of the following: LPA Calderon interviewed Staff S1-S3, residents R1-R4, Witness W1-W2. LPA Calderon obtained the following records: Physician report (dated 08/27/2024), Admission Agreement (dated 02/23/2024), Incident report (dated 04/27/2026), Medication record (dated 04/01/2026 to 04/26/2026), Needs and Service (dated 10/24/2025) for R1. Toured the facility with S1
The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026

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 11-AS-20260428084903

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: CASA DEL SOL RESIDENCE	FACILITY NUMBER: 198602190
	VISIT DATE: 05/06/2026

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

Regarding the Allegation: Staff mismanages residents’ medication.

This complaint alleged that the facility staff did not give the right medication for R1. Records review indicate the following: Physician report (dated 08/27/2024) indicates that R1 has cognitive issues and needs help with medications. Incident report (dated 04/27/2026) indicates that R1 was aggressive with staff and that staff had given medication based on doctors’ orders. Reviewed MAR for April 2026 for R1. MAR indicates that staff gave all medications as ordered. Reviewed Needs and Service (dated 10/24/2025) indicates that R1 needs help from staff with medications. Interviews indicate the following: R1 could not be interviewed due to not living at the facility. R2-R4 deny the allegation. S1 indicates that staff give the proper medications to R1 and all residents. S2-S3 deny the allegation. W1-W2 indicate that they visit R1 every day and did not see any issues with medications given to R1. W1-W2 indicate that R1 never told them staff were not giving the proper medications to R1. Toured the facility and noted staff giving medications to residents in care.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff mismanages residents’ medication” is found to be UNSUBSTANTIATED.

Regarding the Allegation: Staff speak inappropriately to residents.

This complaint alleged that the facility staff spoke to R1 inappropriately. Records review indicate the following: Physician report (dated 08/27/2024) indicates that R1 has cognitive issues. Incident report (dated 04/27/2026) indicates that R1 was aggressive with staff. LPA Calderon toured the facility and did not note any negative interaction with staff. Interviews indicate the following: R1 could not be interviewed due to R1 not living at facility. R2-R4 deny the allegation. S1-S3 deny the allegation. W1-W2 indicates that they visit R1 every day and did not notice any issues with staff and were not advised by R1 of any issues with speaking with staff.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff speaks inappropriately to resident” is found to be UNSUBSTANTIATED.

No deficiencies cited during today's visit.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Staff Valerie Hanson (S1).

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2