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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600536
Report Date: 04/02/2026
Date Signed: 04/02/2026 05:05:33 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
03/24/2026 and conducted by Evaluator Mayra Cota
COMPLAINT CONTROL NUMBER: 28-AS-20260324101430
FACILITY NAME:SIERRA GUEST HOMEFACILITY NUMBER:
198600536
ADMINISTRATOR:SHIRAZI, ALI ASGHARFACILITY TYPE:
735
ADDRESS:5039 FIESTA AVENUETELEPHONE:
(626) 309-9266
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY:6CENSUS: 5DATE:
04/02/2026
UNANNOUNCEDTIME BEGAN:
08:34 AM
MET WITH:Marites Jacinto, DSP and
Marilyn Acabal, Administrator 		TIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Staff do not have required training.
Facility does not have a disaster plan.
Staff do not ensure fire drills are conducted as required.
Staff did not ensure there is a first aid manual at the facility.
Staff files are incomplete.
Client files are incomplete.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced 10-day complaint visit to investigate the above-mentioned allegations. LPA met with Marilyn Acabal, Administrator and Marites Jacinto, DSP, and the reason for the visit was explained.

The investigation consisted of the following:

LPA, toured the facility, obtained staff and client rosters, conducted interviews with Staff 1 – Staff 2 (S1-S2) and reviewed Staff 1 – Staff 6 (S1-S6) and Client 1 – Client 5 (C1-C5) files.

The investigation revealed the following:

***Continues on LIC 9099-C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
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 7
Control Number 28-AS-20260324101430
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: SIERRA GUEST HOME
FACILITY NUMBER: 198600536
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/10/2026
Section Cited
CCR
80023(d)
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Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
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Administrator will document the planned drills on facility calendar and will schedule drills in advance as a reminder. Administrator will send LPA, the list of dates for planned drills for the year 2026 by POC due date.
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Per record review, the facility's last two fire/disaster drills were conducted in 5/3/2025 and 1/20/2026 which indicated that drills are are not being conducted at least every six months, which poses a potential health and safety risk for clients in care.
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Type B
04/10/2026
Section Cited
CCR
80023(a)
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Disaster and Mass Casualty Plan (a) Each licensee shall have and maintain on file a current, written disaster and mass casualty plan of action.

This requirement is not met as evidenced by:
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Administrator will complete the plan and conduct in-service training to discuss the plan with the staff. Staff will post the plan in a prominent place to have it readily available. A copy of the disaster plan and proof of in-service training will be emailed to LPA by POC due date.
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Per record review, the facility does not have an Emergency and Disaster Plan in place, which poses a potential health and safety risk for clients in care.
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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: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 28-AS-20260324101430
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: SIERRA GUEST HOME
FACILITY NUMBER: 198600536
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/10/2026
Section Cited
CCR
80075(g)(1)(A)
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Health Related Services (g)... first aid supplies shall be maintained and be readily available in a central location in the facility. (1) The supplies shall include at least the following: (A) A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency.
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Administrator will send LPA a copy of the purchase receipt of the manual by POC due date.
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This requirement is not met as evidenced by:
Based on staff interviews and LPA observation, the facility does not have a current edition of a First Aid Manual, which poses a potential health and safety risk for clients in care.
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Type B
04/10/2026
Section Cited
CCR
80075(f)
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Health Related Services(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.
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Administrator will send proof of certification for S3 and S4 by POC due date, via email or text.
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This requirement is not met as evidenced by:
Per staff interview, S3 and S4 do not have a current First Aid/CPR certification because they have not taken the training.
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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: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 28-AS-20260324101430
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: SIERRA GUEST HOME
FACILITY NUMBER: 198600536
VISIT DATE: 04/02/2026
NARRATIVE
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Regarding: Staff do not have required training.

It is alleged that staff have not completed required training.

Review of staff files by LPA during today’s visit revealed that S3 and S4 do not have a current First Aid/CPR certification. Interview with S1 indicated that S3 and S4 have not taken the recertification training for First Aid/CPR because S1 did not monitor the expiration dates and did not follow up on reminding staff to recertify. Based on record review and staff interview, the allegation that staff do not have the required training is corroborated.

Regarding: Facility does not have a disaster plan.

It is alleged that the facility does not have a disaster plan.

Review of records conducted by LPA during today’s visit revealed that the facility does not have a copy of the Emergency and Disaster Plan in the facility. Interview with S2 indicated that they do not know where the plan is kept in the facility and therefore, was unable to provide LPA with a copy during visit. Interview with S1 revealed that the facility does not have a hard copy of the plan in the facility. S1 stated that they keep a copy of the plan on their computer, however; when reviewed on the computer by LPA, the Emergency and Preparedness Plan was observed incomplete. The plan was observed to be missing information in elements I through J. Based staff interviews, observation and record review, the allegation that the facility does not have a disaster plan in place is corroborated.

Regarding: Staff do not ensure fire drills are conducted as required.

It is alleged that no fire drills were conducted in the last six months.

Interview with S2 indicated that the facility conducts fire/disaster drills every month; however, record review by LPA during today’s visit revealed that the facility’s last three drills were conducted on 5/18/2024, 5/3/2025 and 1/20/2026 which were not conducted within the compliance time frame of every six months. Further interview with S2 indicated that they do not have any other records to indicate that the facility is conducting drills. Based on staff interviews and record review, the allegation that the facility is not conducting fire drills every six months is corroborated.

***Continues on LIC 9099-C page 2***

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 28-AS-20260324101430
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: SIERRA GUEST HOME
FACILITY NUMBER: 198600536
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/10/2026
Section Cited
CCR
80066(a)
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Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee...
This requirement is not met as evidenced by:
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Administrator will print and place current certifications in S1 and S5's file and send LPA a photo of printed copies in staff files by POC due date.
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Per record review, proof of recertification was not present in S1 and S5’s staff files even though they had already taken the training, which poses a potential health and safety risk for clients in care.
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Type B
04/17/2026
Section Cited
CCR
80070(a)
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Client Records (a) The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client.
This requirement is not met as evidenced by
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Administrator will print and send LPA, photos of printed copies of Behavior Reports in staff files by POC due date.
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Per interview and record review conducted by LPA, (5) out of (5) clients are missing their current Quarterly Behavior Reports which poses a potential health and safety risk for clients in care.
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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: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 28-AS-20260324101430
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: SIERRA GUEST HOME
FACILITY NUMBER: 198600536
VISIT DATE: 04/02/2026
NARRATIVE
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Regarding: Staff did not ensure there is a First Aid manual at the facility.

It is alleged that the facility does not have a First Aid manual.

Interview with S1 indicated that the facility keeps a current edition of the First Aid manual which is typically stored on the kitchen counter below the medication cabinet; however, S1 was unable to find it during today’s visit. Interview with S2 indicated that they have not seen a First Aid Manual and stated that they are not familiar with what the manual looks like. S2 also attempted to find the First Aid manual but could not locate it during visit. LPA did not observe the First Aid manual in the facility during tour of the home. Based on interviews and observation, the allegation that the facility did not ensure that there is a First Aid manual in the facility is corroborated.

Regarding: Staff files are incomplete.

It is alleged that staff files are missing training documents.

Interview with S1 revealed that S1 and S5 have recertified their First Aid/CPR training. However, S1 has not printed a copy of S1 and S5’s current CPR cards and placed them in their staff files. During review of staff files conducted by LPA during today’s visit, proof of recertification was not present in S1 and S5’s staff files. S1 retrieved S1 an S5’s current First Aid/CPR cards but could not make a photostatic copy to place in each staff’s file. Based on interview and record review, the allegation that staff files are incomplete is corroborated.

Regarding: Client files are incomplete.

Interview with S1 revealed that the facility does not have the current Quarterly Behavior Reports for (5) out of the (5) clients living in the facility. S1 indicated that the clients in care are receiving Applied Behavior Analysis (ABA) services from consultants every two weeks; however, the facility does not have the most recent reports with the formulated behavioral plans on file, which are provided to facility staff for implementation. Review of client files by LPA revealed that (5) out of (5) clients are missing their current Quarterly Behavior Reports. Based on interview and record review, the allegation that client files are incomplete is corroborated.

Based on LPA’s observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations (Title 22), are being cited on the attached LIC 9099-D. An exit interview was conducted with Marilyn Acabal, and a copy of this report, LIC 9099-D and Appeal Rights was provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 7