198601562-2-26-2026-28-AS-DSIS-DRU25A-20260303160511

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601562
Report Date: 02/26/2026
Date Signed: 02/26/2026 10:54:16 AM

Unsubstantiated

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
09/09/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250909084241

FACILITY NAME:	AMBIRIA HOMES II		FACILITY NUMBER:	198601562
ADMINISTRATOR:	SHAWNTRIS LEAKE		FACILITY TYPE:	735
ADDRESS:	8141 VICTORIA AVE.		TELEPHONE:	(323) 567-2842
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY:	4	CENSUS: 4	DATE:	02/26/2026
		UNANNOUNCED	TIME BEGAN:	09:34 AM
MET WITH:	Eboni Campbell - Administrator		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Questionable Death
Staff did not seek timely medical attention for resident in care

INVESTIGATION FINDINGS:

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** This report supersedes report dated 2/19/2026. The reason for the supersede and the subsequent visit is to correct the dates listed on report listed on the LIC9099-C page, all findings remain the same**
Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Administrator Eboni Campbell and explained the reason for the visit.

The investigation consisted of the following:
On 9/10/25 LPA conducted an initial health and safety check visit, obtained a copy of Medical Record visit dated 9/1/2025 and requested the following information to be emailed: Staff/Client Rosters and most recent notes for emergency correspondence along with contact names and phone numbers that were called. On 2/4/26 LPA obtained a copy of Client #'1 death certificate
During todays visit LPA conducted interviews with 6 Staff (S1-S6) and 1 witness (W1), interviews with 4 clients were not completed due to residents intellectual and cognitive disabilities, LPA delivered findings on the reported allegations. (Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

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-20250909084241

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: AMBIRIA HOMES II	FACILITY NUMBER: 198601562
	VISIT DATE: 02/26/2026

NARRATIVE

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The investigation revealed the following:
Allegation: Questionable Death
It is alleged that the death of C1 is questionable as C1 had only shown signs of a common cold prior to passing. LPA interviewed 6 staff and each denied the allegation, staff stated that although C1 was experiencing common cold symptoms, staff stated that although the passing of C1 was unexpected they did know at some time it will happen given their age and other health conditions. LPA interviewed C1’s Service Coordinator (W1) and they stated that C1 did have a history of experiencing a cold, cough and runny nose, and that facility would be in close contact with them if there were any changes of condition or questions regarding C1. W1 further stated that when the passing of C1 was provided it did come as a shock but given C1’s age and other health conditions it was never seen as questionable or due to negligence on the facility or facility staff’s behalf. LPA obtained a copy of C1’s Death Certificate and the cause of death was listed as; cardiopulmonary arrest, cardiac arrhythmia, hypertension (contributing factor but not cause: intellectual disability), which does not rise suspicion of questionable death.
Allegation: Staff did not seek timely medical attention for resident in care
It is alleged that staff did not take C1 to seek medical care at the early signs of the cold that they had been experiencing prior to passing. LPA obtained copies of phone records and communication logs, the documentation revealed that staff and management were in communication with C1’s cough and runny nose, C1 was taking PRN for cough that was at the facility, C1’s primary care physician was called to set an appointment during the first observations of sign of cough that was reported on 9/30/25, Administrator called physician same day 9/30/25, an appointment was made for a televisit with doctor for 9/1/25 at 3pm, notes indicated doctor never called for televisit and the facility planned to take C1 to hospital if doctor did not call by end of business day of 9/2/25. C1 Passed on 9/2/25 at 5pm and unfortunately did not make it to the hospital. LPA interviewed 6 staff and each denied the allegation and stated that it was common for C1 to have a cough and runny nose, that staff followed procedure and notified management of condition and C1 was being monitored until the scheduled visit with their physician. LPA interviewed W1 and they stated that C1 was known to have an on and off again runny nose and cough, they have visited facility unannounced on many occasions and have never observed anything unusual or alarming and have close contact with the administrator on questions and concerns with the clients at the facility.
Based on statements and interviews conducted with staff and review of C1's files and death report, the cause of death does not appear to be suspicious or due to any neglect, therefore the findings are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

LIC9099 (FAS) - (06/04)

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