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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601666
Report Date: 05/19/2026
Date Signed: 05/19/2026 12:04:37 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
05/14/2026 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260514114108
FACILITY NAME:SPECIALIZED RESIDENTIAL MAVERICK CIRCLEFACILITY NUMBER:
198601666
ADMINISTRATOR:AGUILA, AGNESFACILITY TYPE:
735
ADDRESS:1 MAVERICK CIRTELEPHONE:
(909) 629-2453
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:4CENSUS: 3DATE:
05/19/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Hanako Beltran, DSPTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff verbally abused resident.
Staff physically abused resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Konishi conducted an initial unannounced 10-day complaint visit at the facility and met with Direct Support Professional (DSP), Hanako Beltran and LPA explained the purpose of the visit. The Administrator, Agnes Aguila arrived shortly after and LPA explained the purpose of the visit.

The investigation consisted of the following: LPA interviewed the Administrator, Staff #1 (S1), and Staff #2 (S2). LPA interviewed Client #1 (C1), Staff #3 (S3), and Witness #1 (W1) over the phone. LPA obtained copies from C1’s file such as Face Sheet, Individual Program Plan (IPP), and other pertinent documents. LPA attempted to interview Client #2 (C2) but LPA was unable to interview C2 since C2 was unable to answer the LPA’s questions. LPA attempted to interview Client #3 (C3) over the phone but LPA was unable to interview C3 since C3 was unable to answer the LPA’s questions. LPA also obtained the staff, client rosters, staff training, and other pertinent documents.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026
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 3
Control Number 28-AS-20260514114108
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: SPECIALIZED RESIDENTIAL MAVERICK CIRCLE
FACILITY NUMBER: 198601666
VISIT DATE: 05/19/2026
NARRATIVE
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The investigation revealed the following: in regards to the allegation "Staff verbally abused resident.” It is alleged that the Administrator was upset with C1 and the Administrator yelled at C1. LPA interviewed the Administrator, and three (3) out of three (3) staff that denied the allegation stating that they have not observed S1 verbally abuse or yell at C1 in a abusive manner. Administrator, and three (3) out of three (3) staff stated that the staff assertively speak to C1 to help de-escalate and re-direct C1 and also stated that the staff do not speak in an abusive manner. The Administrator, and three (3) out of (3) staff also stated that C1 has a history of verbal aggression, fabrications and makes allegations toward staff. LPA interviewed C1 that corroborated with the allegation stating that the Admin and other staff yell at C1. C1 named the other two (2) clients at the home as witnesses. However, the other two (2) clients were unable to answer LPA’s questions regarding that incident. C1 was also unable to recall when this incident occurred and was unable to recall any other witnesses of the incident. LPA interviewed W1 that stated that C1 has a history of verbal aggression and false allegations toward staff. LPA reviewed all documentation that C1 has a history of verbal aggression, false allegations, and fabrications. LPA also obtained staff in-service training dated 1/23/2026 covering Mandated Reporter, Client Rights and Rights to Dignity. There is not enough sufficient evidence to substantiate.

Allegation: “Staff physically abused resident.” It is alleged that the Administrator pushed C1 to the ground. The Administrator, and three (3) out of three (3) staff denied the allegation stating that they have not physically abused or pushed C1 to the floor and have not witnessed other staff physically abuse or pushed C1 to the floor. The Administrator, and three (3) out of (3) staff stated that C1 would engage in physical aggression, behavioral outburst, fabrications, and self-injurious behaviors. The Administrator and three (3) out of three (3) staff stated that when C1 engages in self-injurious behavior or physical aggression, staff conducts re-direction and de-escalation. LPA interviewed C1 that corroborated with the allegation stating that the Admin pushed and dragged C1 to the floor. C1 named the other two (2) clients at the home as witnesses. However, the other two (2) clients were unable to answer LPA’s questions regarding that incident. C1 was unable to recall when this occurred and was unable to recall any other witnesses of the incident. LPA interviewed W1 that stated that C1 has a history of physical aggression and false allegations toward staff. LPA reviewed all documentation that C1 has a history of physical aggression, behavioral outbursts, self-injurious behavior, false allegations, and fabrications. LPA reviewed records, Administrator, S1 to S3 has valid CPI (Crisis Prevention Intervention) training certificates.

[Continue to LIC9099-C]
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260514114108
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: SPECIALIZED RESIDENTIAL MAVERICK CIRCLE
FACILITY NUMBER: 198601666
VISIT DATE: 05/19/2026
NARRATIVE
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LPA also obtained staff in-service training dated 2/27/2026 covering Abuse, Neglect, and Rights for Individuals with Developmental Disabilities. LPA also obtained staff in-service training dated 3/27/2026 covering Crisis Intervention for Individuals with Developmental Disabilities. There is not enough evidence to substantiate.

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 allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was held and a copy of this report was provided to the Administrator, Agnes Aguila.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3