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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191592401
Report Date: 05/09/2026
Date Signed: 05/09/2026 04:40:32 PM

Substantiated


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
02/19/2026 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260219141148
FACILITY NAME:BLUE HAVEN GUEST HOME IFACILITY NUMBER:
191592401
ADMINISTRATOR:MARILOU & EDGARDOFACILITY TYPE:
735
ADDRESS:7207 NORWALK BLVDTELEPHONE:
(562) 695-4905
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY:6CENSUS: 5DATE:
05/09/2026
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Amalia Yanson TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff mismanaged clients' funds.
Staff did not ensure that clients in care had reasonable privacy.
Staff did not provide proper supervision to clients in care.
Facility does not have a waiver to retain clients over age of 60.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 05/09/2026 regarding the above allegations. LPA conducted initial complaint investigation on 02/20/2026 and a need further investigation was documented. During today’s visit LPA Ramirez was greeted by Amalia Yanson and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff#1 interview (S1), Client#3,5 interview (C3, C5), attempted interview of Client#1-2,4 (C1-C2, C4), copy of Eastern Los Angeles Corrective Action Plan (CAP), copies of C1- C5’s: Identification and Emergency Information, Admission Agreement, Individual Program Plan (IPP), Physician’s Report, copies of C1,C2 and C4’s: Record of Client’s/Resident’s Safeguarded Cash Resources (LIC 405), and physical plant tour.
SEE 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026
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-20260219141148
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: BLUE HAVEN GUEST HOME I
FACILITY NUMBER: 191592401
VISIT DATE: 05/09/2026
NARRATIVE
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The investigation revealed the following: regarding the allegation “Staff mismanaged clients' funds.” It is staff mismanaged clients’ funds by not maintaining accurate and current ledger of clients’ cash resources. Two (2) out of the two (2) staff interviews corroborated this allegation. LPA attempted interviews with C1, C2 and C4. Due to documented intellectual disabilities, and because C1, C2 and C4 are non-speaking or use limited speech, their responses could not be relied upon. Interview with C3 and C5 did not corroborate this allegation. Interview with C1-C5’s placement agency revealed that in February 2026, it was discovered that facility staff was not accurately logging C1, C2 and C4’s cash balances for the month of December 2025. Review of Eastern Los Angeles Corrective Action Plan (CAP) corroborated this allegation. Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

“Staff did not ensure that clients in care had reasonable privacy” It is alleged that staff did not ensure clients’ in care had locks on their bedroom doors. Two (2) out of the two (2) staff interviews corroborated this allegation. LPA attempted interviews with C1, C2 and C4. Due to documented intellectual disabilities, and because C1, C2 and C4 are non-speaking or use limited speech, their responses could not be relied upon. Interview with C3 and C5 did not corroborate this allegation. Interview with C1-C5’s placement agency revealed that staff should have installed bedroom door locks on C1-C5’s doors per HCBS federal requirements, last year. Review of Eastern Los Angeles Corrective Action Plan (CAP) corroborated this allegation. Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

SEE 9099-C
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20260219141148
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: BLUE HAVEN GUEST HOME I
FACILITY NUMBER: 191592401
VISIT DATE: 05/09/2026
NARRATIVE
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“Staff did not provide proper supervision to clients in care” It is alleged that staff did not follow required 1:3 staffing ration in January 2026. Two (2) out of the two (2) staff interviews corroborated this allegation. LPA attempted interviews with C1, C2 and C4. Due to documented intellectual disabilities, and because C1, C2 and C4 are non-speaking or use limited speech, their responses could not be relied upon. Interview with C3 and C5 did not corroborate this allegation. Interview with C1-C5’s placement agency revealed that they reviewed staffing timesheets for 01/14/2026 which revealed there was only one (1) staff from 8am to 12pm, 1pm-9pm and no staff providing direct care/supervision from 12pm-1pm and after 9pm. From 01/05/26 through 01/08/26, there was one (1) staff from 6pm-8pm and no staff providing direct care/supervision after 8pm. On 01/09/26, there was 1 staff from 2pm-5pm, 6pm-10pm and no staff providing direct care/supervision until 8am, from 4pm-9pm there was only one (1) staff and no staff after 9pm providing direct care/supervision. Review of Eastern Los Angeles Corrective Action Plan (CAP) corroborated this allegation. Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

“Facility does not have a waiver to retain clients over age of 60” It is alleged that four (4) out of the five (5) client’s in care are over the age of 60 and the facility does not have an approved aged over exception on file. Two (2) out of the two (2) staff interviews corroborated this allegation. LPA attempted interviews with C1, C2 and C4. Due to documented intellectual disabilities, and because C1, C2 and C4 are non-speaking or use limited speech, their responses could not be relied upon. Interview with C3 and C5 did not corroborate this allegation. Interview with C1-C5’s placement agency corroborated this allegation. Review of Eastern Los Angeles Corrective Action Plan (CAP) corroborated this allegation. Review of the facility file did not reveal this facility has requested or been approved for an aged over exception, for clients in care. During review of client files, LPA Ramirez observed that four (4) out of the five (5) clients in care are over 60 years of age. Based on interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

Based on LPAs observations and interviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 & 6 are cited on the attached LIC 9099D.

Four (4) deficiencies were cited during this complaint investigation. A copy of this report, 9099-D and appeals rights was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 28-AS-20260219141148
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: BLUE HAVEN GUEST HOME I
FACILITY NUMBER: 191592401
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/10/2026
Section Cited
CCR
85065.5(a)(1)
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(a) client who relies upon others to perform all activities of daily living is present, the followin staffing requirements shall be met:(1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center no less than 1 direct care staff to 3 such clients.
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Administrator agreed to submit plan (due by 5/10/26) on when retraining will be conducted. Administrator agreed to conduct staff retraining in this regulation and send proof of retraining to LPA by 05/17/2026
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This requirement was not met as evidenced by: Several days in Jan 2026, staffing was not the 1:3 ratio. This poses an immediate risk to the health, safety, or personal rights of persons in care.
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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: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20260219141148
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: BLUE HAVEN GUEST HOME I
FACILITY NUMBER: 191592401
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2026
Section Cited
CCR
80026(h)(1)
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(h) Licensee shall maintain accurate records of accounts of cash resources, entrusted to his/her care:(1)Records of clients' cash resources maintained as a drawing account, shall include a current ledger accounting, columns for income, disbursements,balance, for each client.
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Licensee agreed to conduct staff retraining on this regulation by 5/17/2026. Licensee will send proof of retraining by 05/17/26, via email.
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This requirement was not met as evidenced by: Licensee did not maintain accurate and current ledger for C1,C2, and C4, for December 2026. This poses a potential risk to the health, safety, or personal rights of persons in care.
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Type B
05/09/2026
Section Cited
CCR
80072(a)(2)
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(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Licensee placed locking mechanisms on all client bedroom doors. This clears POC, no further action required.
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This requirement was not met evidenced by: client bedroom doors were not equipped with locking mechanisms. This poses a potential risk to the health, safety, or personal rights of persons in care.
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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: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20260219141148
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: BLUE HAVEN GUEST HOME I
FACILITY NUMBER: 191592401
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2026
Section Cited
CCR
85068.4(h)
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(g) If acceptance or retention of an individual 60 yrs of age or older would result in the number of persons 60 yrs of age or older exceeding 50 percent of the census in facilities with a capacity of six or fewer clients, the licensee must request an
exception in order to accept or retain the
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Administrator agreed to submit aged over exception requests for C3 & C5 by 05/17/26, via email to LPA Ramirez
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 individual. This requirement was not met as evidenced by: 4 out of 5 clients are over 60 yrs old and the facility does not have an exception in order to retain clients over 60 yrs old. This poses a potential risk to the health, safety, or personal rights of persons in care.
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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: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6