198602619-5-15-2026-11-AS-EMAZ-DUJU4E-20260529151500

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602619
Report Date: 05/15/2026
Date Signed: 05/15/2026 02:50:36 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
03/30/2026 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260330170205

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:	05/15/2026
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Jonathan Stump		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility is providing insufficient staffing.

INVESTIGATION FINDINGS:

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On 05/15/26, at 1:00pm, the department conducted a subsequent visit to interview clients about the allegation and to update the report conducted on 04/09/2026.

On 4/09/26, at 10:15am, 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 deliver findings for the allegation mentioned above.

The investigation consisted of the following: The department investigated the allegation mentioned in this complaint and conducted interviews with staff (S1-S5) and clients (C1-C3). The department received the following documents: Staff Roster (Dated: April 2026) and Staff Personnel Records from the facility.

The investigation revealed the following: Allegation-Facility is providing insufficient staffing.

Report Continued On LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

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 11-AS-20260330170205

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: 05/15/2026

NARRATIVE

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The details of the complaint alleged that the facility’s staffing is insufficient to meet the needs of the clients. On 4/09/2026, from 10:15am-12:00pm, the department interviewed staff (S1-S5) and on 05/15/2026 the department interviewed clients (C1-C3) regarding the allegation. 5 of 5 staff denied the allegation that Facility is providing insufficient staffing. All staff stated that they work in the facility various shifts and hours during the week and weekends. Staff also 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-C3) about the allegations and 2 out of 3 clients denied that there is insufficient staffing. While one client, due to cognitive difficulties, was not able to participate in the interview fully. Client (C2-C3) stated that they are never left alone and that staff are always here to take care of them. The department asked if there are staff when you wake and when you go to bed, C2-C3 stated yes, staff are always here.

The department observed that the clients are at the day program from 9:00am-1:00pm Monday through Friday. The department reviewed the staff roster and verified scheduling by interview and observed that staff are scheduled Monday through Sunday on various shifts overlapping one another to cover a 24-hour period.

Based on interviews and records that were reviewed, there is insufficient evidence to support the allegation that Facility is providing insufficient staffing. 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 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: 05/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2026

LIC9099 (FAS) - (06/04)

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