198320286-3-19-2026-11-AS-JHAD-DSWRKL-20260407130544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320286
Report Date: 03/19/2026
Date Signed: 03/19/2026 01:56:57 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
03/11/2026 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260311101558

FACILITY NAME:	ACOSTA FAMILY HOME I		FACILITY NUMBER:	198320286
ADMINISTRATOR:	ACOSTA, ASHLEY		FACILITY TYPE:	735
ADDRESS:	1540 EAST CYRENE DRIVE		TELEPHONE:	(310) 997-5615
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY:	4	CENSUS: 3	DATE:	03/19/2026
		UNANNOUNCED	TIME BEGAN:	09:17 AM
MET WITH:	Ashley Acosta		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Lack of care and supervision client is left unattended.

INVESTIGATION FINDINGS:

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On 3/19/26, at 9:10am, the department conducted an initial complaint visit to the facility and was greeted by Ashley Acosta, Administrator. The department explained the purpose of this visit was to gather information about the complaint, gather facility files, interview staff and clients, and deliver findings for the allegation mentioned above.

The investigation consisted of the following: The department investigated the allegation mentioned in this complaint and conducted interviews with staff (S1-S4) and clients (C1-C3). The department received the following documents: Staff Roster (Dated: 09/11/25), Client Roster (Dated: 04/13/23), Face Sheets (Dated: 05/26/23), ID/Emergency Information (Dated: No Date), Individual Program Plans (Dated: 05/16/25, 05/27/25), and Physician’s Report (Dated: 01/21/25, 01/21/25) from the facility.

Report Continued On LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260311101558

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: ACOSTA FAMILY HOME I	FACILITY NUMBER: 198320286
	VISIT DATE: 03/19/2026

NARRATIVE

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The investigation revealed the following: Allegation- Lack of care and supervision client is left unattended.

The details of the complaint alleged that the facility’s client (C1) is often left alone due to inadequate staffing. It was reported that due to inadequate staffing levels there is a concern about the well-being and appropriateness of the care the client is receiving. On 3/19/2026, from 9:30am-2:00pm, the department interviewed staff (S1-S4) and clients (C1-C3) regarding the allegation. 4 of 4 staff denied the allegation that because of Lack of care and supervision client is left unattended. All staff stated that the clients are never left alone at the facility and that there are always staff present to take care of the clients. They stated that client (C1) does not go to a day program because they do not like the program. So, they said the client is always with a staff member and never left alone.

The department interviewed clients (C1-C3) about the allegations and 3 out of 3 clients denied being left alone. All clients stated that they are always with staff and feel safe living in the facility.

The department reviewed the staff personnel roster and observed that the facility has a sufficient number of staff to supervise the clients in care for all shifts.

Based on interviews and records that were reviewed, there is insufficient evidence to support the allegation that because of Lack of care and supervision client is left unattended. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies were found and no citations were issued for this complaint investigation.

An exit interview was conducted with Ashley Acosta, Administrator, and a hard copy of this Complaint Investigation Report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

LIC9099 (FAS) - (06/04)

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