198602619-1-17-2026-11-AS-JHAD-DQYPQ8-20260204103043

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602619
Report Date: 01/16/2026
Date Signed: 01/17/2026 12:59:50 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
12/05/2025 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20251205143431

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: 2	DATE:	01/16/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ashley Ascota		TIME COMPLETED:	05:06 PM

ALLEGATION(S):

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Staff did not assist resident with personal hygiene care.
Staff did not ensure resident had clean clothing.
Staff did not ensure resident received adequate food service.
Staff did not adequately supervise residents.

INVESTIGATION FINDINGS:

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On January 16, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit. Ashley Acosta admnistrator and Jonathan Stump DSP greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegations mentioned above.

The investigation included a collection of records and a tour of the facility. The Department collected several documents, Client #1 (C1’s) service records included Identification and Emergency Information LIC 601 (dated 08/22/15), Functional Capability Assessment LIC 9172 (dated 08/22/15), Preplacement Appraisal Information LIC 603 (dated 03/26/21), Admissions Agreement (dated 8/22/15), South Central Los Angeles Regional Center Individual Program Plan (dated 07/25/24), Physicians Report LIC 602 (dated 01/30/25), and other pertinent records associated with this complaint. Interviews conducted with Staff #1-#2 (S1-S2), Client #1-#2 (C1-C2), and Witness #1-#5 (W1-W5).
(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026

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-20251205143431

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: 01/16/2026

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff did not assist resident with personal hygiene care.

Allegation #2: Staff did not ensure resident had clean clothing.

It is alleged that the staff failed to assist Client #1 with personal hygiene, resulting in a decline in the quality of care at this facility and raise concerns about potential neglect. Reports indicate that Client #1 has been observed wearing soiled diapers, unclean clothing, and improperly fitted shoes. Additionally, extra clothing belonging to Client #1 has been found saturated with sweat, feces, and mildew. Further claims suggest that the administrator was informed of these concerns but took no action to address them. No additional details about this allegation have been provided.

On December 11, 2025, and January 16, 2026, between 11:10 AM and 2:15 PM, the Department interviewed two clients, identified as Client #1 (C1) and Client #2 (C2). Neither of these two clients was able to confirm the claim. Client #2 (C2) stated (C2) received assistance with personal hygiene and had no concerns or issues with the services provided by the staff. Additionally, (C2) claimed not wearing soiled or dirty clothing out in the community.

Client #1 (C1) was interviewed but could not engage in a conversation due to (C1’s) health condition.

On December 11, 2025, and January 16, 2026, between 10:00 AM and 4:09 PM, the Department interviewed two staff members identified as Staff #1 and Staff #2 (S1-S2). Both staff members stated that the claim against them is false. They confirmed that Client #1 (C1) experiences incontinence and wears diapers. However, they asserted that (C1) has always received prompt assistance with incontinence care and has never left the facility in soiled or dirty clothing. (S1-S2) asserted that they did not pack any alternative clothing or pull-up diapers that were unclean or had an unpleasant odor. Demonstrative evidence was presented to (S1- S2), who both denied its validity.

On January 5, 2026, January 7, 2026, and January 16, 2026, between 10:00 AM and 03:39 PM, the Department interviewed witness members identified as Witness#1 through Witness #5 (W1-W5). Three (3) out of five (5) could not support this claim. (W3-W5) stated that during their visits, they had not observed any clients at the facility wearing unkempt, soiled diapers or dirty clothing.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20251205143431

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: 01/16/2026

NARRATIVE

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Witness #3 (W3) expressed having no concerns regarding the personal hygiene care of Client #1 (C1) and mentioned that the facility provided adequate care and supervision services.

During the investigations on December 11, 2025, and January 16, 2026, the Department noted that no clients had issues with personal hygiene. The clients were generally presentable in appearance and wore appropriate clothing. The Department concluded that the facility upholds its clients' rights. Posters outlining Resident Rights, Personal Rights, and the California Residential Care Facilities for the Elderly Complaint Poster were prominently displayed throughout the facility.

Based on information gathered, there is insufficient evidence to support the allegation mentioned above.

Allegation #3: Staff did not ensure resident received adequate food service.

It is alleged that the facility failed to provide adequate food services for Client #1 (C1). Reports indicate that (C1) is malnourished and is not receiving three meals a day, which has resulted in significant weight loss and constant hunger. Furthermore, additional reports indicate that the snacks or lunches provided are of poor quality, not appropriately packaged, and stored in plastic trash bag rather than lunchboxes. No further details regarding this allegation have been provided.

On December 11, 2025, and January 16, 2026, between 11:10 AM and 2:15 PM, the Department interviewed two clients, identified as Client #1 (C1) and Client #2 (C2). Neither of these two clients was able to support the claim. Client #2 (C2) reported (C2) received three meals daily with snacks. (C2) claimed to have no issues with the quality or the amount of food provided by the facility.

Client #1 (C1) was interviewed but could not engage in a conversation due to (C1’s) health condition.

On December 11, 2025, and January 16, 2026, between 10:00 AM and 4:09 PM, the Department interviewed two staff members, referred to as Staff #1 and Staff #2 (S1 and S2). Both staff members asserted that the claims made against them are unfounded. They confirmed that Client #1 (C1) frequently snacks and always seems to need something to eat. (S1-S2) reported that clients receive three meals a day along with snacks. They indicated that the snacks prepared for clients while they are out in the community include fruits, veggie sticks, trail mix, and yogurt, providing a good combination of protein and fiber.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20251205143431

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: 01/16/2026

NARRATIVE

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(S1- S2) denied any claims that (C1) has experienced significant weight loss in recent months or that meals have been packaged in trash bags. When presented with demonstrative evidence, (S1-S2) both disputed its validity.

On January 5, 2026, January 7, 2026, and January 16, 2026, between 10:00 AM and 03:39 PM, the Department interviewed the witness members identified as Witness #1 through Witness #5 (W1-W5). Three (3) out of five (5) could not support this claim. (W3-W5) stated that they had no concerns regarding the clients being underfed or malnourished. Specifically, Witness #3 (W3) expressed that they had no worries about Client #1 (C1) receiving adequate meals.

On December 11, 2025, and again on January 16, 2026, the Department inspected the food supply. It highlighted at least a 7-day supply of nonperishables and a 2-day supply of perishables. During the inspections, the Department found a wide variety of fresh fruits and vegetables, grains, and dairy products. The facility had all items that met the required quality and safety standards. The range of snack containers observed was deemed sufficient. A review of Client #1 (C1's) monthly weight log showed no indications of significant weight loss.

Based on information gathered, there is insufficient evidence to support the allegation mentioned above.

Allegation #4: Staff did not adequately supervise residents.

It is alleged that Staff #1 (S1) did not adequately supervise Client #1 (C1). Reports indicate that on one occasion, (S1) failed to arrive on time to pick up C1 from an outing. Additionally, (S1) did not answer the door for approximately 20 minutes, raising concerns about S1's preparedness to care for (C1). No further details regarding this allegation have been provided.

On December 11, 2025, and January 16, 2026, between 11:10 AM and 2:15 PM, the Department interviewed two clients, identified as Client #1 (C1) and Client #2 (C2). Neither of these two clients was able to support the claim. Client #2 (C2) reported the staff are good and they are responsive with care and supervision. (C2) claimed that he is never left alone without a staff member on duty.

Client #1 (C1) was interviewed but could not engage in a conversation due to (C1’s) health condition.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20251205143431

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: 01/16/2026

NARRATIVE

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On December 11, 2025, and January 16, 2026, between 10:00 AM and 4:09 PM, the Department conducted interviews with two staff members, referred to as Staff #1 (S1) and Staff #2 (S2). Both staff members claimed that the allegation is false.

(S1), who is responsible for duties Monday through Friday from 8:00 AM to 10:00 AM and 1:00 PM to 8:00 PM, stated that there has never been an issue with (S1’s) availability to respond promptly when clients return from daily outings. (S2) affirmed that the facility has sufficient staff members working three shifts to adequately care for and supervise clients throughout the day.

On January 5, 2026, January 7, 2026, and January 16, 2026, from 10:00 AM to 3:39 PM, the Department conducted interviews with five witnesses, referred to as Witness #1 through Witness #5 (W1-W5). Four (4) out of the five (5) witnesses could not support the claim in question. Furthermore, (W3-W5) reported that they had no issues or concerns regarding any staff members or the services provided to clients. They have never observed inadequate care or supervision by the staff at this facility.

A review of Client #1 (C1’s) service records included Identification and Emergency Information LIC 601 (dated 08/22/15), Functional Capability Assessment LIC 9172 (dated 08/22/15), Preplacement Appraisal Information LIC 603 (dated 03/26/21), Admissions Agreement (dated 8/22/15), South Central Los Angeles Regional Center Individual Program Plan (dated 07/25/24), Physicians Report LIC 602 (dated 01/30/25), Road community Care Clinic Report (dated 10/15/25), Monthly Weight Tracking (dated 01/25 through 11/25), Quarterly Nursing Progress Note (dated 11/24 through 01/25), and Medication Administration Record (dated 10/1/25 through 10/31/25). Further review of facility records included: Weekly Meal Planner (dated 10/25 & 11/25), Meeting In-Service Training (dated 01/25), Staff Communication Log (dated 10/02/25 through 12/3/25), and Employee Schedule (dated 09/25 through 11/25).

Based on information gathered, there is insufficient evidence to support the allegation mentioned above.

Based on the information gathered from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are Unsubstantiated.

An exit interview was conducted with Ashley Acosta, and copies were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026

LIC9099 (FAS) - (06/04)

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