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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600536
Report Date: 04/20/2026
Date Signed: 04/20/2026 03:34:08 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:
04/20/2026
UNANNOUNCEDTIME BEGAN:
09:47 AM
MET WITH:Marilyn Acaba, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff was not competent in their duties.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced subsequent visit to deliver findings regarding the above-mentioned allegations. LPA, met with Marilyn Acabal, Assistant Administrator, and the reason for the visit was explained. Administrator, Ali Shirazi, was informed regarding today’s visit, via telephone call.

The investigation consisted of the following:

During initial 10-day complain visit, LPA, toured the facility, obtained staff and client rosters, conducted interviews with Staff 1 and Staff 3 (S1 and S3) and reviewed Staff 1 – Staff 6 (S1-S6) and Client 1 – Client 5 (C1-C5) files.

During today’s visit, LPA conducted tour of the facility , interviewed Staff 2 (S2) and reviewed facility’s Activity Calendars for March – April 2026.
***Continues on LIC 9099-C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
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 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
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:
04/20/2026
UNANNOUNCEDTIME BEGAN:
09:47 AM
MET WITH:Marilyn Acabal, Assistant AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not have planned activities.
INVESTIGATION FINDINGS:
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2
3
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5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced subsequent visit to deliver findings regarding the above-mentioned allegations. LPA, met with Marilyn Acabal, Assistant Administrator, and the reason for the visit was explained. Administrator, Ali Shirazi, was informed regarding today’s visit, via phone call.
The investigation consisted of the following:

During initial 10-day complain visit, 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.

During today’s visit, LPA, interviewed Staff 3 – Staff 4 (S3-S4) and reviewed facility’s Activity Calendars for March – April 2026.
***Continues on LIC 9099-C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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: 04/20/2026
NARRATIVE
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The investigation revealed the following:

Regarding: Facility does not have planned activities.

It is alleged that staff are not planning community and leisure activities for clients in care.

Staff deny the allegation. Interviews with (5) out of (5) staff indicated that the facility plans their activities according to clients’ interests. Staff indicated that clients are taken on outings they choose throughout the week. Staff indicated that clients are taken on shopping trips, restaurants, parks, museums and strolls around the neighborhood to keep physical activity going. Staff also indicated that activities are planned monthly and are documented on the activities calendar which they post in the kitchen. Furthermore, staff stated that they will make changes to the calendar depending on client feedback, weather conditions or by prioritizing doctor or dental appointments for clients. Any missed activities are postponed and rescheduled accordingly. During visit, LPA reviewed Activity Calendar for March and April 2026. LPA observed the April 2026 calendar posted in the kitchen. Review of the calendar indicated that the facility plans for church services, shopping trips, leisurely entertainment, fitness routines, arts and crafts, board and tabletop games and “choice of activity”. Interviews with (2) out of (5) clients indicated that the facility provides outings and activities and they like what they do at the facility. Three (3) clients were not responsive to LPA’s questions during interview attempt.

Based on interviews, observations and record review, the allegation staff are not planning community and leisure activities for clients could not be corroborated.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, Marilyn Acabal, Administrator, and a copy of this report was provided.

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

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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: 04/20/2026
NARRATIVE
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The investigation revealed the following:

Regarding: Staff was not competent in their duties.

It is alleged that staff brought their child to the facility during staff’s work hours which interrupted client's scheduled services.

During interview, S1 acknowledged that on 2/17/2026, S3’s child was at the facility while clients were in care. S1 indicated that the child was placed in the back room of the home while child waited for another family member to pick child up. S1 indicated that S3 had no one to watch the child and therefore allowed S3 to bring their child to work. S1 further indicated that child was eventually picked up by a family member after several hours of being at the facility. S1 also acknowledged that C1’s day program activities had not started due to S3’s child being at the facility while waiting to be picked up. Interview with S3 revealed that S3 had to bring their child to work on 2/17/2026 because they had no one to watch the child at the time. S3 indicated that S1 gave S3 consent to bring their child to work and that child was eventually picked up at the facility by a family member. S3 further acknowledged that it was a mistake to bring their child to work because it posed a safety concern for child and clients in care. Interview with S2 revealed that staff’s children should not be at the facility at any time and that C1’s services should not have been interrupted due the set-back caused by the child being at the facility.

Interviews corroborate the allegation that staff brought their child to the facility during staff’s work hours which interrupted client's scheduled services. The preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22), is being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report was provided.

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

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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: 04/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2026
Section Cited
CCR
80065(a)
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Personnel Requirements:
(a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.
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Licensee will provide staff with training regarding facility policy regarding unauthorized persons at the facily and staff duties to ensure care and supervision to clients in care by POC due date. Proof of trainings will be emailed to LPA by POC due date.
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This requirement is not met as evidenced by:
S3's child was observed to be at the facility on 2/17/2026 during S3's work shift which is against facility policy and prevented C1 from being taken to day program as scheduled, which poses and 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: 04/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5