<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601448
Report Date: 12/18/2025
Date Signed: 12/18/2025 07:48:37 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
12/15/2025 and conducted by Evaluator Gabriela Castro
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251215092542
FACILITY NAME:A AND M III HOME CAREFACILITY NUMBER:
198601448
ADMINISTRATOR:ANA ALARCIOFACILITY TYPE:
735
ADDRESS:537 CONVERSE AVETELEPHONE:
(909) 618-7065
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:6CENSUS: 4DATE:
12/18/2025
UNANNOUNCEDTIME BEGAN:
07:38 AM
MET WITH:Ana Alarcio, Administrator and Mona DeLa RosaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit clients
Staff pushed clients
Staff does not treat clients with respect
Staff denied clients access to water
Staff mismanaged clients medication
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced complaint visit to deliver findings regarding the above allegations. LPA met with Ana Alarcio and Mona De La Rosa and explained the purpose of the visit.

The investigation consisted of the following: On 12/18/25, LPA obtained copies of staff and resident rosters; Face Sheet/Identification documents; physician’s medication orders for four (4) clients; and staff CPI training records. LPA conducted interviews with seven (7) staff members (S1–S7), four (4) clients (C1–C4), and one (1) witness (W1).

(Continued on LIC9099-C)

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
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-20251215092542
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: A AND M III HOME CARE
FACILITY NUMBER: 198601448
VISIT DATE: 12/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegations: Staff hit and Staff Pushed Client

It is alleged that on December 10 at approximately 2:30 p.m., a Direct Support Professional hit client and pushed a client during a behavioral episode. It is further alleged that the same staff member yelled at clients and used derogatory language toward them. It is alleged that this behavior is ongoing and not an isolated incident, and that other clients may have been treated in a similar manner. It is further alleged that staff have used objects, including a broomstick, to intimidate clients and cause them to remain quiet or comply with staff direction.

During client interviews, clients C1–C4 were identified as non-verbal. LPA attempted to interview client C1 regarding the above allegations; however, the client was unable to respond due to difficulty understanding. . During observations, clients were observed to appear comfortable in their surroundings. During record review LPA obtained current certified CPI training. Additionally, LPA was informed that clients have not been placed in CPI holds, as the facility utilizes positive behavior support plans in lieu of physical interventions.



During the investigation, LPA spoke with witness #1 (W1) who previously conducted a wellness check at the facility. The witness reported no concerns related to client care, staff interactions, or client safety at the time of the wellness check.

During staff interviews, staff members S1–S7 provided consistent responses and reported they have not observed any staff hitting and pushing. Staff stated that when clients become agitated or upset, staff attempt to calm them by asking what is wrong and identifying the client’s needs. Staff reported that behavioral interventions are de-escalation based and do not involve the use of force, threats, or aggressive actions.

(Continued on LIC9099-C)
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20251215092542
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: A AND M III HOME CARE
FACILITY NUMBER: 198601448
VISIT DATE: 12/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff does not treat clients with respect

It is alleged that staff do not treat clients with respect, including yelling at clients, using inappropriate or derogatory language and failing to interact with clients in a dignified and respectful manner.

In regard to the allegation that staff do not treat clients with respect, clients C1–C4 were identified as non-verbal. LPA attempted to interview client C1 and asked whether the client likes living at the facility; however, the client was unable to respond due to not understanding. Due to communication limitations, clients were unable to verbally respond to questions regarding staff interactions. During observations, LPA observed clients to be well dressed, clean, and appropriately groomed. Clients appeared excited and engaged while preparing to leave for their day program, which included a planned party. Clients were observed to appear comfortable in their surroundings and did not display signs of distress at the time of the visit.

During staff interviews, staff members S1–S7 were interviewed regarding the above allegation. Staff reported that they care for all residents and stated they would never mistreat them. All staff interviewed reported they have not observed or witnessed any abuse or mistreatment by facility staff. Staff denied observing any instances in which staff failed to treat clients with respect, including yelling or using inappropriate language. Staff described expectations for respectful interactions with clients as providing care in a calm, patient, and supportive manner.

(Continued on LIC9099-C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20251215092542
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: A AND M III HOME CARE
FACILITY NUMBER: 198601448
VISIT DATE: 12/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff denied clients access to water

It is alleged that staff denied clients access to water. During client interviews, clients C1–C4 were identified as non-verbal; therefore, LPA was unable to obtain verbal responses regarding the above allegation. During observations, LPA observed clients C2 and C3 requested water, and staff were observed to promptly provide water to both clients.

During staff interviews, staff members S1- S7 were interviewed regarding the above allegation. Staff reported that clients are provided with access to drinking water throughout the day and that staff provide water whenever a client requests it. Staff further reported that clients typically leave for their day program with a water bottle and that clients have individually labeled water bottles stored in the facility refrigerator and made available as needed. LPA observed labeled water bottles for each client in the refrigerator. Staff confirmed they would not prevent clients from accessing drinking water. LPA observed the facility has filtered water and emergency water supply.


Allegation: Staff mismanaged resident’s medication

It is alleged that staff are mismanaging medication for a client with bowel movement concerns by not administering the prescribed amount of medication in order to avoid having to clean bowel movements.


During the investigation, LPA reviewed medication records for four (4) clients (C1–C4), including Medication Administration Records (MARs) and related documentation, to determine whether medications were administered as prescribed. The review determined that clients C2 and C3 are prescribed medication related to bowel movement management. MARs for clients C1–C4 were reviewed and observed to be accurately documented and reflective of medications being administered in accordance with physician orders.
During staff interviews, staff members S1–S5 were interviewed regarding the above allegation. Staff reported that medications are administered in accordance with physician orders and that they adhere to prescribed dosages and documentation requirements. Staff stated they follow established procedures when clients experience bowel movement concerns and denied withholding prescribed medications.

(Continued on LIC9099-C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20251215092542
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: A AND M III HOME CARE
FACILITY NUMBER: 198601448
VISIT DATE: 12/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on direct observation, statements and interviews conducted with staff/residents there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was held, and a copy of this report was provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5