198600235-5-6-2026-11-AS-SCIS-DUQQU3-20260604122804

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600235
Report Date: 05/06/2026
Date Signed: 05/06/2026 11:53:02 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
04/27/2026 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20260427112747

FACILITY NAME:	ULTIMATE CARE 11		FACILITY NUMBER:	198600235
ADMINISTRATOR:	COLLETTE JOHNSON RAMIREZ		FACILITY TYPE:	735
ADDRESS:	601 CENTER STREET		TELEPHONE:	(310) 640-8686
CITY:	EL SEGUNDO	STATE: CA	ZIP CODE:	90245
CAPACITY:	6	CENSUS: 4	DATE:	05/06/2026
		UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Manger Deborah Lewis		TIME COMPLETED:	12:01 PM

ALLEGATION(S):

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Facility staff are not providing information to authorized representative

INVESTIGATION FINDINGS:

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On 05/06/26 at 9:30 am Licensing Program Analyst (LPA) Villegas conducted a initial complaint visit regarding the allegation(s) above. LPA met with Manger Deborah Lewis (staff #1, S1) as the purpose of today’s visit was explained.

The investigation consisted of the following: On 05/06/26 LPA Villegas obtained copies of the staff and client rosters, and copies of the following documents for client#1 (C1) Emergency ID form, Admission agreement dated:03/19/2004, Physicians report dated: 03/30/2026 , Individual program plan dated: 06/17/25, Behavior Consultation Services dated: June 2025. On 05/06/26 from 9:30 am- 10:30 am LPA conducted Interviews with (S1-S2). LPA unable to conduct interviews with Clients #1-4 due to communication barriers. On 05/06/26 LPA conducted telephone interview with Witnesses #1-2 (W1-W2).

The investigation revealed the following:
Allegation: Facility staff are not providing information to authorized representative.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
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)

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Control Number 11-AS-20260427112747

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: ULTIMATE CARE 11	FACILITY NUMBER: 198600235
	VISIT DATE: 05/06/2026

NARRATIVE

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It is being alleged that facility staff have not been providing updates on client care as facility telephone is not answered. On 05/06/26 from 9:50 am- 10:30 am LPA conducted Interviews with S1-S2 regarding the allegation above. 2 of the 2 staff interviewed denied the allegation above and report that updates are provided when requested by the responsible parties. Additionally, S1-S2 reported that the facility telephone is always answered unless there is no one at the facility. On 05/06/26 LPA was unable to conduct interviews with C1-C4 due to communication barriers. On 05/06/26 LPA conducted a review of C1's file, LPA was able to confirm authorized representative for C1. On 05/06/26 LPA conducted telephone interview with W1-W2 regarding the allegation above. W1 and W2 denied the allegation above and reported having no concerns about the care being provided nor have issues getting in contact with facility staff.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
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)

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