198601502-3-17-2026-28-AS-DSIS-DSCUSQ-20260320155042

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601502
Report Date: 03/17/2026
Date Signed: 03/17/2026 09:58:13 AM

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
02/12/2026 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260212152015

FACILITY NAME:	RAYMOND HOUSE		FACILITY NUMBER:	198601502
ADMINISTRATOR:	HAMILTON, DAVID		FACILITY TYPE:	735
ADDRESS:	872 N RAYMOND AVE		TELEPHONE:	(626) 792-8813
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	22	CENSUS: 0	DATE:	03/17/2026
		UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Greg Tillman, Staff		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

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Staff hit resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced subsequent 10-day complaint visit at the facility and upon arrival, no one answered the door. At 9:45am, Staff, Greg Tillman arrived shortly after and LPA discuss the purpose for today's visit to investigate the above allegation.

On 2/17/2026, the initial investigation visit was conducted. The investigation consisted of the following:
The investigation consisted of the following: LPA requested copies of the staff roster and client roster which Staff #2 (S2) will send to the LPA by COB. LPA requested copies from Client #1 (C1’s) file such as Face Sheet, Physician’s Report, Individualized Program Plan (IPP), Client Notes, Special Incident Reports, and other pertinent documents which S2 will send to the LPA by COB. LPA requested copies from Staff #1 (S1’s) files Staff Training and other pertinent documents to the LPA by COB.

On 2/27/2026, LPA interviewed Client #2 (C2) and Client #3 (C3), Staff #1 (S1), Staff#3 (S3), Staff #4 (S4) and Staff #5 (S5) over the phone. LPA attempted to interview Client #4 (C4) and Client #5 (C5) over the phone but was unable to conduct the interviews since C4 and C5 could not answer the questions.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260212152015

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: RAYMOND HOUSE	FACILITY NUMBER: 198601502
	VISIT DATE: 03/17/2026

NARRATIVE

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LPA interviewed Witness #1 (W1) and Witness #2 (W2) over the phone. LPA attempted interview C1 by trying to obtain C1’s current contact information but no one could provide C1’s contact information.
On 3/13/2026, LPA interviewed Witness #3 (W3) over the phone.

During today's visit the investigation revealed the following: in regards to the allegation "Staff hit resident.", it is alleged that on 10/30/2025, C1 was physically hit on the arm and abdomen by S1. LPA interviewed S1 and two (2) out of two (2) staff that denied the allegation by stating that S1 have never hit C1 and other clients on 10/30/2025. LPA interviewed S1 and two (2) out of two (2) staff that indicated that the incident between C1 and S1 actually occurred on 10/30/2024 in which C1 was physically and verbally aggressive and threw food on the floor in front of C1’s room. Per S1 and two (2) staff, C1 went outside of the house that day and when two (2) female staff went to clean up the food that was spilled by C1’s room, C1 got upset and ran toward two (2) female staff attempting to hit them. S1 prevented C1 from approaching the two (2) female staff by getting in between being a barrier acting as self-defense and a shield from C1 to not attack the two (2) female staff. C1 pushed S1 to the wall. S1 verbally redirected C1 in which shortly after, C1 calmed down and went to the front porch. S1 stated that S1 did not hurt C1. C1 left the facility and the last day of residing at the facility was 10/30/2024. LPA interviewed an additional two (2) staff that denied the allegation stating that S1 did not hit C1 and they witnessed C1 getting upset and ran towards the two (2) female staff and S1 prevented C1 approaching the two (2) female staff. These two (2) staff also stated not hitting C1 and any other clients. LPA was unable to interview C1 since LPA was unable to obtain C1’s contact information, phone number or a location of residence. Per Clients Notes dated October 2024, C1 has a history of aggression, being disruptive, and displaying negative target behavior. LPA interviewed two (2) out of four (4) clients that denied the allegation by stating that they have never seen S1 hit C1. Those two (2) out of four (4) clients also stated that they have never been hit by S1 or any other staff. LPA attempted to interview two (2) out of four (4) clients that could not confirm nor deny the allegation and were unable to be interviewed since they were unable to answer questions. LPA interviewed W1 that provided photos by text of bruises on an arm and leg but unable to confirm that C1 is the person in the photo since there is no facial identification of C1. Per Special Incident Report received on 10/31/2024, there was no injury reported as a result from the incident. Frank D. Lanterman Regional Center also conducted an investigation of the incident that occurred on 10/30/2024 and findings concluded the allegations of physical abuse were unsubstantiated. LPA reviewed the facility staff files of the staff members involved in the incident that have current valid CPI training. There is not enough evidence to substantiate.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260212152015

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: RAYMOND HOUSE	FACILITY NUMBER: 198601502
	VISIT DATE: 03/17/2026

NARRATIVE

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Based on statements and interviews conducted with staff, clients, review of client files and facility file records, 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 held, and a copy of this report was provided to Staff, Greg Tillman.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026

LIC9099 (FAS) - (06/04)

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