198200906-4-9-2026-11-AS-SCIS-DT5QMQ-20260414121757

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198200906
Report Date: 04/09/2026
Date Signed: 04/09/2026 03:59:38 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
10/21/2025 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20251021142919

FACILITY NAME:	ALTIUS II ADULT RESIDENTIAL		FACILITY NUMBER:	198200906
ADMINISTRATOR:	PEDRO PEREZ		FACILITY TYPE:	735
ADDRESS:	3745 W. 157TH STREET		TELEPHONE:	(310) 973-8249
CITY:	LAWNDALE	STATE: CA	ZIP CODE:	90260
CAPACITY:	6	CENSUS: 4	DATE:	04/09/2026
		UNANNOUNCED	TIME BEGAN:	11:51 AM
MET WITH:	Maricela Pacheco, House Manager		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Client sustained Clavicle fracture while in care.

INVESTIGATION FINDINGS:

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On 4/9/2026, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. Upon arrival, LPA met with the House Manager, Maricela Pacheco, and explained that the purpose of today's visit is to investigate and deliver findings for the allegations mentioned above and was granted entrance to facility grounds.

The investigation consisted of the following:
On 10/22/25 LPA Felisa Shirley made copies of the following records: Client Face Sheet/Personal Information, Physician’s Report, IPP Baseline of Behaviors, Consumer Relationship Info, Admission Agreement, Regional Incident Report, and Facility contact information. The Department conducted interviews with Staff 1 to staff 3(S1-S3), Witness 1 to Witness 3(W1-W3) and Client 1 to Client 4(C1 – C4).

Con’d on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

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 3

Control Number 11-AS-20251021142919

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: ALTIUS II ADULT RESIDENTIAL	FACILITY NUMBER: 198200906
	VISIT DATE: 04/09/2026

NARRATIVE

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Investigation revealed the following:

Allegation: Client sustained Clavicle fracture while in care.

It is being reported that C1 sustained an injury due to neglect and lack of supervision. On 2/17/26, Licensing Program Analyst, (LPA) Felisa Shirley reviewed medical records from Long Beach Medical Center, dated, 10/19/25. Per medical records, C1 received a diagnosis of a “Closed nondisplaced fracture of sternal end of left clavicle” and a “Hematoma of left chest wall.” Dr. Farhood Saremi, MD stated that the hematoma appears to be old, it appeared that C1 had an initial injury and hematoma and the bruising was starting to dissipate. C1 had that yellow slightly mottled appearance of an old bruise and did not feel that this is a recent injury. During review of medical reports from MemorialCare Long Beach Medical Center, LPA Shirley observed that C1 has a past medical history of seizures. Per interview with S1 on 11/5/25, she didn’t notice any bruises during C1’s shower on 10/18/25 prior to C1’s visit to family home. On 2/17/26, LPA Shirley reviewed correspondences from Access Services, Risk Management Coordinator, dated 10/27/25, stating that footage was reviewed for C1 during transport to family residence on 10/18/25. The correspondence confirmed that there were no reported incidents involving C1. Per interview with W3, Westside Regional Staff on, 12/18/25, it was verified that there is no supplemental staff supervision required for C1. Therefore, the possibility of an unwitnessed fall or unwitnessed injurious event cannot be ruled out.

con'd on 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20251021142919

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: ALTIUS II ADULT RESIDENTIAL	FACILITY NUMBER: 198200906
	VISIT DATE: 04/09/2026

NARRATIVE

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LPA interviewed staff 1 – Staff 3(S1 – S3). Of those interviewed 3 out of 3 denied the allegation. LPA attempted to interview Client-1 – Client-4(C1 – C4). Of those who interviewed 1 out of 1 denied the allegation. Three of the clients are Non-Verbal.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Client sustained Clavicle fracture while in care,” therefore, the allegation is unsubstantiated.

No deficiencies were cited for these allegations.

An exit interview was conducted and a copy of this report was provided to the House Manger, Maricela Pacheco.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

LIC9099 (FAS) - (06/04)

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