198600271-9-25-2025-28-AS-WSHO-DM4RKR-20251003130559

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600271
Report Date: 09/25/2025
Date Signed: 09/25/2025 02:01:49 PM

Unsubstantiated

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
09/16/2025 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250916195553

FACILITY NAME:	HAMILTON VILLA		FACILITY NUMBER:	198600271
ADMINISTRATOR:	ADELA SANTOS		FACILITY TYPE:	735
ADDRESS:	948 SOUTH HAMILTON BLVD.		TELEPHONE:	(909) 620-1933
CITY:	POMONA	STATE: CA	ZIP CODE:	91766
CAPACITY:	84	CENSUS: 60	DATE:	09/25/2025
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Adela Santos		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff did not provide adequate supervision resulting in client wandering away from facility.
Unknown individual physically abuses client.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted a visit to investigate the above allegations. LPA met with Adela Santos and discussed the purpose of today's visit.

During today's visit, LPA obtained a copy of the staff and client rosters, reviewed file for Client #1 (C-1) and obtained relevant documentation, interviewed C-1's Public Guardian, interviewed Staff #1 (S-1) through Staff #5 (S-5) and interviewed Client #3 (C-3) through Client #8 (C-8). LPA was unable to interview Client #1 (C-1) and Client #2 (C-2) as both were not present at the time of this visit.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

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 28-AS-20250916195553

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: HAMILTON VILLA	FACILITY NUMBER: 198600271
	VISIT DATE: 09/25/2025

NARRATIVE

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It has been alleged that staff did not provide adequate supervision resulting in client wandering away from facility. Staff interviews revealed that staff provide adequate supervision to clients in care. Interviewed staff indicated that C-1 is able to leave this facility independently (per C-1’s physician report, C-1 is able to leave the facility unassisted). Interviewed staff indicated that C-1 has a history of leaving this facility and at times does not return. Interviewed staff indicated that when C-1 does not return, a missing person’s report is filed with the Pomona Police Department and C-1’s Public Guardian is notified. Interviewed staff indicated that at times, C-1 calls the facility and requests staff to pick up C-1 from different locations in which staff do. C-1’s Public Guardian confirmed that staff provide notification when C-1 goes missing and did not have any concerns pertaining to staff supervision. Interviewed staff indicated that they have not received any complaints pertaining to this matter. Client interviews revealed that staff provide adequate supervision. Interviewed clients indicated they are able to leave this facility independently. Interviewed clients indicated that they do not have any concerns pertaining to this matter. Staff and client interviews do not corroborate this allegation.

It has been alleged that an unknown individual physically abuses client. Staff interviews revealed that staff nor clients abuse C-1. Interviewed staff indicated that they have not received any concerns/complaints pertaining to this matter. Staff interviews revealed that C-1 has a history of fabricating stories. Client interviews revealed that they are not physically abused nor have witnessed anyone being physically abused. Interviewed clients indicated that they have not heard anyone complaining about this matter. Interviewed clients indicated that they do not have any concerns pertaining to this matter. Staff and client interviews do not corroborate this allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview conducted, a copy of the report and appeal rights were provided to Adela Santos.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

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