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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600521
Report Date: 12/23/2024
Date Signed: 12/23/2024 02:56:20 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
12/19/2024 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241219152927
FACILITY NAME:KAISER SPECIALIZED RESIDENTIAL ALHAMBRAFACILITY NUMBER:
198600521
ADMINISTRATOR:MASAYON, HIRAMOWEN (OWEN)FACILITY TYPE:
735
ADDRESS:1101 GERANIO DRTELEPHONE:
(626) 281-3424
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:4CENSUS: 4DATE:
12/23/2024
UNANNOUNCEDTIME BEGAN:
01:59 PM
MET WITH:Hiramowen (Owen) Masayon, AdministratorTIME COMPLETED:
02:59 PM
ALLEGATION(S):
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RSO is allegedly associated or present in the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez conducted a complaint visit to deliver findings for the allegation; RSO is allegedly associated or present at the facility. LPA met with Administrator Hiramowen (Owen) Masayon and explained the purpose of the visit.

Investigator Douglas Real who is part of the CDSS Investigative Branch conducted the initial investigation on 12/19/2024. The Registered Sex Offender (RSO) was not the facility during the investigator’s visit. However, he was associated and employed by the facility. The RSO was called by Administrator and asked to come to facility and was given Order to Individual of Immediate Exclusion from All Facilities Order. The individual left the premises without incident after being served the letter.
LPA interviewed staff during the visit. Staff confirmed individual has been on premises several times and recently has been on premises almost daily.

(Continued on 9099C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
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 28-AS-20241219152927
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: KAISER SPECIALIZED RESIDENTIAL ALHAMBRA
FACILITY NUMBER: 198600521
VISIT DATE: 12/23/2024
NARRATIVE
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(Continued from 9099)

Based on evidence obtained during the course of the investigation, the department has substantiated that an individual who has been convicted of a crime for which registration as a registered sex offender (RSO) is required, has contact with clients of or presence in, a facility licensed by the Department that creates a risk or harm to the health and safety of clients in care. Therefore, the allegation is found to be substantiated.

According to the California Code of Regulations, Title 22 Division 6, and Chapter 8 the following deficiency is being cited on the attached LIC 9099D. Civil penalties issued.

Exit interview held, A copy of report and appeal rights were provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 28-AS-20241219152927
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: KAISER SPECIALIZED RESIDENTIAL ALHAMBRA
FACILITY NUMBER: 198600521
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
12/24/2024
Section Cited
CCR
80019(e)(2)
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80019 Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility:
(2) Obtain a California clearance or a criminal record exemption as required by the Department or
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Administrator will disassociate S1 immediately and send LPA proof and written statement on how this will be avoided in the future.

$500 immediately civil penalty assessed.
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This deficiency is not met evidenced by:

S1 (RSO) is associated by facility and was present at facility on12/18/2024 and almost daily before 12/18/2024
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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.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3