198602619-3-17-2026-11-AS-JHAD-DSWRHR-20260407130246

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602619
Report Date: 03/17/2026
Date Signed: 03/17/2026 02:45:53 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
03/11/2026 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260311111206

FACILITY NAME:	ACOSTA FAMILY HOME III		FACILITY NUMBER:	198602619
ADMINISTRATOR:	ACOSTA, ASHLEY		FACILITY TYPE:	735
ADDRESS:	875 S ARANBE AVE		TELEPHONE:	(310) 554-4824
CITY:	COMPTON	STATE: CA	ZIP CODE:	90220
CAPACITY:	6	CENSUS: 3	DATE:	03/17/2026
		UNANNOUNCED	TIME BEGAN:	09:17 AM
MET WITH:	Jonathan Stump		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Lack of care and supervision client is left unattended.
Uncleared individuals are residing in the facility.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 3/17/26, at 9:30am, the department conducted an initial complaint visit to the facility and was greeted by Jonathan Stump, Direct Support Professional. The department explained the purpose of this visit was to gather information about the complaint, gather facility files, interview staff and clients, and deliver findings for the allegations mentioned above.

The investigation consisted of the following: The department investigated the allegation mentioned in this complaint and conducted interviews with staff (S1-S3) and clients (C1-C2). The department received the following documents: ID/Emergency Information (Dated: 01/16/21,12/15/21), Preplacement Appraisal Information (Dated: 03/26/21), Individual Program Plan (Dated: 07/25/24), Physician’s Report (dated: 01/20/26), Acosta Home First Aid Follow Up (Dated: 03/12/26), Special Incident Report (Dated: 03/12/2026), Face Sheet (Dated: 12/15/21), and Nonviolent Crisis Intervention Staff Training (Dated: 07/22/25-07/22/27) from the facility.

Report Continued On LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
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)

Page: 1 of 2

Control Number 11-AS-20260311111206

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: ACOSTA FAMILY HOME III	FACILITY NUMBER: 198602619
	VISIT DATE: 03/17/2026

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

The investigation revealed the following: Allegation #1- Lack of care and supervision client is left unattended.

The details of the complaint alleged that the facility’s clients are often left alone, and the administrator is consistently unavailable. It was reported that due to inadequate staffing levels, clients have been left unattended at the home. On 3/17/2026, from 9:30am-2:00pm, the department interviewed staff (S1-S3) and clients (C1-C2) regarding the allegation. 3 of 3 staff denied the allegation that because of Lack of care and supervision client is left unattended. All staff stated that the clients are never left alone at the facility and that there are always staff present to take care of the clients.

The department interviewed clients (C1-C2) about the allegations and 1 out of 2 clients denied being left alone. While one client, due to cognitive difficulties, was not able to participate in the interview fully.

The department reviewed staff files and interviewed staff about scheduling and observed that the facility has a sufficient number of staff to supervise the clients in care.

Based on interviews and records that were reviewed, there is insufficient evidence to support the allegation that because of Lack of care and supervision client is left unattended. 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.

Allegation #2- Uncleared individuals are residing in the facility.

The details of the complaint alleged that the licensee has a family member that resides at the facility and has direct access to the clients. It was reported that they have not been cleared by the Community Care Licensing Division (CCLD). On 3/17/2026, from 9:30am-2:00pm, the department interviewed staff (S1-S3) regarding the allegation. 3 of 3 staff denied the allegation that Uncleared individuals are residing in the facility. All staff stated that there are no uncleared individuals or staff who are not associated with the facility residing in the facility or living there.

The department reviewed staff files and observed that all individuals were associated to work at the facility.

Based on interviews and records that were reviewed, there is insufficient evidence to support the allegation that because of Uncleared individuals residing in the facility. 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.

No deficiencies were found and no citations were issued for this complaint investigation.

An exit interview was conducted with Jonathan Stump, Direct Support Professional, and a hard copy of this Complaint Investigation Report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
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)

Page: 2 of 2