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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320286
Report Date: 04/09/2026
Date Signed: 04/10/2026 08:16:32 AM

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
03/30/2026 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20260330161931
FACILITY NAME:ACOSTA FAMILY HOME IFACILITY NUMBER:
198320286
ADMINISTRATOR:ACOSTA, ASHLEYFACILITY TYPE:
735
ADDRESS:1540 EAST CYRENE DRIVETELEPHONE:
(310) 997-5615
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:4CENSUS: 3DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:TIME COMPLETED:
04:59 PM
ALLEGATION(S):
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Unqualified staff providing supervision.
Facility is providing insufficient staffing.
INVESTIGATION FINDINGS:
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On April 9, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit. Israel Montoya Direct Support Provider and Ashley Acosta administrator greeted the LPA. LPA explained that the purpose of the visit is to investigate the allegations mentioned above.

The investigation included a collection of records, interviews and tour of the facility. The Department collected Register of Faciltiy Clients LIC 9020, Personnel Report LIC 500 (dated 09/11/25 & 04/01/26), Employee Schedule (dated 12/01/26 through 04/30/26), Direct Support Professional Training Class certification,California Department of Social Services (CDSS), Care Provider Management Bureau Guardian, Employee Contact Information, and other documents pertinent or associated with this complaint.

(Evaluation Report continues LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
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-20260330161931
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: 04/09/2026
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Unqualified staff providing supervision.
Allegation #2: Facility is providing insufficient staffing.

It is alleged that the facility has unqualified staff providing care and that staffing is insufficient. Reports indicate that the night staff providing care are underage and not qualified. It is also reported that the facility is operating with insufficient staffing. No further information has been provided regarding this matter.

On April 01, 2026, and April 07, 2026, between 04:30 PM and 11:50 PM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members could not corroborate these claims. All three staff members affirmed that the facility employs only qualified individuals, emphasizing that no underage employees are present. (S1-S3) stated that there is an adequate number of staff for each shift, ensuring optimal coverage. (S1) indicated that every staff member has completed the mandatory Direct Support Professional Training. Furthermore, (S1-S3) assured that all clients receive continuous care and supervision, with none left unattended. It confirmed that there is no need for one-on-one caregiving services for any clients. Staff #4 and #5 (S4-S5) were unable to participate in an interview and did not respond to telephone calls.

On April 01, 2026, and April 09, 2026, between 03:15 PM and 11:15 PM, the Department interviewed clients identified as Client #1 through Client #3 (C1-C3). Three (3) out of the three (3) clients were unable to confirm these claims. (C1-C3) expressed that they have not observed any underage staff at this facility, and they have never encountered any instances of unqualified personnel. They noted the presence of adequately trained staff, ensuring that someone is always available to provide essential care and supervision to clients.

On April 1, 2026, between 10:30 PM and 11:50 PM, the Department observed one staff member working the evening shift who is not underage and had completed mandatory Direct Support Professional Training providing care and supervision for clients. The staff was verified to have criminal clearance on file.

A review of the current facility’s Personnel Report LIC 500 (dated 09/11/15 & 04/11/25) and Employee Schedule (dated 12/01/26 through 04/30/26) indicates that staffing requirements are adequate in number.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
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-20260330161931
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: 04/09/2026
NARRATIVE
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Further review of the Direct Support Professional Training Class certification verified that all Staff have completed the mandatory training. A review of the California Department of Social Services (CDSS), Care Provider Management Bureau, Guardian verified that all employed staff have criminal clearance. A review of Client #1 through Client #3 (C1-C3)'s Physician's Report (Dated: 05/16/25 & 05/27/25) and Individual Program Plan(Dated: 05/16/25 & 05/27/25).

Based on information gathered, there is insufficient evidence to support the allegations mentioned above.

Based on the information gathered from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are Unsubstantiated.

An exit interview was conducted with Anet Alegria and copies were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
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: 3 of 3