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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602598
Report Date: 06/13/2025
Date Signed: 06/13/2025 04:51:52 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/03/2025 and conducted by Evaluator Troy Watson
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250603150936
FACILITY NAME:IMPERIAL HOUSE #3FACILITY NUMBER:
198602598
ADMINISTRATOR:MBAMALU, EJIKEFACILITY TYPE:
735
ADDRESS:560 W 90TH STREETTELEPHONE:
(323) 422-5427
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:6CENSUS: 4DATE:
06/13/2025
UNANNOUNCEDTIME BEGAN:
08:39 AM
MET WITH:Ronald Brown - House ManagerTIME COMPLETED:
04:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not adequately supervise residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/13/2025 at 8:39AM Licensing Program Analyst (LPA) Troy Watson made an unannounced complaint visit to the above listed facility. LPA Watson was greeted by the House Manager Ronald Brown and explained the purpose of this visit is to investigate the allegation mentioned above.

The investigation consisted of the following:

LPA Watson conducted interviews with residents and staff. LPA Watson requested and received and reviewed the following documents: Register of Facility Clients /Residents: Dated (04/15/24), Appraisal Needs and Services,Patient History and Physical for Adult Day Health Care. Of all the documents reviewed LPA Watson observed that Client #1 is not a client at the facility.

CONTINUED ON LIC9099

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
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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