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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602958
Report Date: 08/28/2025
Date Signed: 08/28/2025 02:24:18 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
01/23/2025 and conducted by Evaluator Felisa Shirley
COMPLAINT CONTROL NUMBER: 11-AS-20250123135529
FACILITY NAME:HOME AWAY FROM HOME ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
198602958
ADMINISTRATOR:THOMAS, MARKFACILITY TYPE:
735
ADDRESS:2714 WEST 108TH STREETTELEPHONE:
(323) 474-5236
CITY:INGLEWOODSTATE: CAZIP CODE:
90303
CAPACITY:3CENSUS: 1DATE:
08/28/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Mark Thomas, AdministratorTIME COMPLETED:
02:22 PM
ALLEGATION(S):
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Staff did not ensure that firearm is stored locked and inaccessible to residents
Staff smoke drugs in the facility.
INVESTIGATION FINDINGS:
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On 8/28/25, Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit to the address listed above. LPA Shirley arrived and spoke to the Administrator, Mark Thomas and the purpose of the visit was discussed. LPA was granted access to the facility.

The investigation consisted of the following:

On 1/31/25 LPA Shirley requested, received and reviewed copies of Staff roster, Client file, Staff Clearance documents, visitor logs, Administrator Certificate, Administrator DSP I and DSP II, and Administrator CPR Card. LPA Shirley and IB Investigator Miles conducted a tour of the facility for a health and safety check. LPA Shirley interviewed Staff 1 and Client 1.

The investigation revealed the following:
Con’d on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
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-20250123135529
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: HOME AWAY FROM HOME ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 198602958
VISIT DATE: 08/28/2025
NARRATIVE
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Allegation: Staff did not ensure that a firearm is stored locked and inaccessible to residents

It is alleged that a member of staff pulled a gun on C1. On 1/31/25, LPA Shirley and Department staff conducted a tour of the facility and observed that there were no clients residing in the facility at this time. During the tour, LPA and Department staff did not observe any firearms.

LPA interviewed Staff - 1(S-1), and he denied the allegation. LPA interviewed Client -1 (C-1). C1 confirmed the allegation.

Based on records review, interviews and observations, LPA did not find sufficient evidence to support the above allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

Allegation: Staff smoke drugs in the facility

It was alleged that staff smokes marijuana in the facility. During the tour of the facility, there was no discernible marijuana odor present. LPA Shirley viewed the Individual Program Plan, IPP dated 10/16/24. Per the IPP, C1 has a history of alcohol and drug use.

On 7/30/25, LPA interviewed Staff - 1(S-1), denied the allegation. LPA interviewed Client - 1(C-1). C1 denied the allegation.

Based on records review, interviews and observations, LPA did not find sufficient evidence to support the above allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies were cited for these allegations.

An exit interview was conducted and a copy of this report was provided to the Administrator, Mark Thomas.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2