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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600271
Report Date: 10/28/2025
Date Signed: 10/28/2025 12:17:52 PM

Substantiated


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
10/24/2025 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251024145932
FACILITY NAME:HAMILTON VILLAFACILITY NUMBER:
198600271
ADMINISTRATOR:ADELA SANTOSFACILITY TYPE:
735
ADDRESS:948 SOUTH HAMILTON BLVD.TELEPHONE:
(909) 620-1933
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:84CENSUS: 60DATE:
10/28/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Adela SantosTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not keep facility free of vermin.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted a visit to investigate the above allegation. 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 Staff #1 (S-1) through Staff #4 (S-4) and interviewed Client #2 (C-2) through Client #7 (C-7). LPA attempted to interview Client #1 (C-1) and Client #8 (C-8) and both refused to be interviewed. LPA also obtained copies of Teminix’s invoices for pest control services provided at this facility for June 2025 through October 2025. A tour was also conducted.

Refer to LIC 9099C for the continuation of this report.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
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 5
Control Number 28-AS-20251024145932
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: 10/28/2025
NARRATIVE
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Allegation: Staff did not keep facility free of vermin. It has been alleged that this facility has bed bugs, rats, and roaches. Staff interviews revealed that there are roaches in this facility. Interviewed staff indicated that the housekeeping staff spray the rooms daily while conducting housekeeping duties. Interviewed staff indicated that a pest control company also provides pest control services at this facility on a monthly basis. Interviewed staff have not seen any rats nor bed bugs. Client interviews revealed that this facility has roaches. Interviewed clients indicated that the cleaning staff “spray” their rooms on a daily basis. Interviewed clients also indicated that a pest company conducts visits to this facility on a monthly basis for pest control services. During the tour, LPA did not observe any bed bugs nor rats. Staff and client interviews corroborate this allegation.

Deficiency cited. Refer to LIC 9099D.

Based on interviews and tour conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

An exit interview was conducted. A copy of this report and appeals rights were provided to Adela Santos.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20251024145932
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/29/2025
Section Cited
CCR
80087(a)
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Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
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Administrator will submit a written statement explaining how Administrator will ensure that this facility will be free of roaches to LPA Irra by POC due date
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This requirement is not being met as evidenced by: Staff and client interviews confirmed that the facility has roaches.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
10/24/2025 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251024145932

FACILITY NAME:HAMILTON VILLAFACILITY NUMBER:
198600271
ADMINISTRATOR:ADELA SANTOSFACILITY TYPE:
735
ADDRESS:948 SOUTH HAMILTON BLVD.TELEPHONE:
(909) 620-1933
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:84CENSUS: 60DATE:
10/28/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Adela SantosTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not ensure client was administered prescribed medication.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted a visit to investigate the above allegation. 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 Staff #1 (S-1) through Staff #4 (S-4) and interviewed Client #2 (C-2) through Client #7 (C-7). LPA attempted to interview Client #1 (C-1) and Client #8 (C-8) and both refused to be interviewed.

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: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20251024145932
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: 10/28/2025
NARRATIVE
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Staff did not ensure client was administered prescribed medication. It has been alleged that C-1 has been oversleeping and not receiving their medication. Staff interviews revealed that clients are provided with their prescribed medication. Interviewed staff indicated that clients are summoned to the medication room via speaker for their medications. Interviewed staff indicated that when a client does not show up for their medication (including if client oversleeps), staff go to the clients’ room and provide them with their medication. Interviewed staff indicated that C-1 is medication complaint and takes all their medications. Interviewed staff indicated they have not received any complaints/concerns pertaining to this matter. Client interviews revealed that they are provided with their prescribed medication on a daily basis. Interviewed clients indicated that they are summoned to the medication room via speaker for their medications. Interviewed clients indicated that when they do not show up for their medication to the medication room, staff go to their rooms and provide them with the medication. Interviewed clients indicated they do not have any concerns pertaining to this matter. Interviews and reviewed documentation do not corroborate this allegation.

Although the allegation(s) 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 was conducted and a copy of this report and appeal rights were provided to Adela Santos.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5