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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602952
Report Date: 01/11/2024
Date Signed: 01/18/2024 01:05:25 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
01/04/2024 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240104165631
FACILITY NAME:A AND M AURORA HOME CAREFACILITY NUMBER:
198602952
ADMINISTRATOR:JOSEPH ESTANISLAOFACILITY TYPE:
735
ADDRESS:555 AUORA DRIVETELEPHONE:
(909) 399-0693
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:4CENSUS: 4DATE:
01/11/2024
UNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Administrator Joseph EstanislaoTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not meeting the needs of a resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an amended report for the purpose of correcting allegation. This amended report does not change the findings.
Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 01/11/24 regarding the above allegations. LPA Ramirez was met by Administrator Estanislao and explained the purpose of the visit. The investigation consisted of the following: LPA Ramirez requested and obtained copies of Staff Roster (LIC 500), Client Roster (LIC 9020), Staff #1 - 6 interviews(S1 – S6), Attempted interview of Client#1- 3 (C1-C3), Nearby neighbors-Witness #1-3 (W1-W3) copies of Client #1-4 (C4): Face Sheet, Identification and Emergency Information, San Gabriel/Pomona Regional Center Individual Program Plan (IPP), Facility/Program Special Incident Reports dated 09/2023 through 11/2023, Receipt dated 01/05/2024, Request for supplies from 12/2023 through 01/11/2024, Bi-weekly Employee Summary Report dated 01/01/2024 through 01/14/2024, Employee handbook and physical plant tour.
SEE 9099-C for continuation.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
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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