198602967-9-13-2025-28-AS-DSIS-DLUUAP-20250925152503

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602967
Report Date: 09/13/2025
Date Signed: 09/13/2025 11:13:11 AM

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
04/15/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250415103132

FACILITY NAME:	DREAM CARE HOME LLC		FACILITY NUMBER:	198602967
ADMINISTRATOR:	CASTRO, MONA		FACILITY TYPE:	740
ADDRESS:	11838 163RD ST		TELEPHONE:	(562) 404-7010
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	6	CENSUS: 4	DATE:	09/13/2025
		UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Mona Castro - Administrator/Licensee		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff did not assist resident with obtaining medical care.
Staff do not allow resident to have confidential telephone calls.
Staff was mimicking the residents disability.
Staff fabricated what happened between two residents.
Resident was wrongfully evicted.
Staff blocked residents phone number to prevent them from calling.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Administrator/Licensee Mona and explained the reason for the visit.

The investigation consisted of the following:
On 9/12/25 LPA interviewed 3 Staff (S1-S3) and 4 Residents (R1-R5) and obtained copies within Resident #1's file. R1 was not interviewed as they are no longer a resident at the facility and was not reachable.
During todays visit 9/13/25 LPA delivered findings for the above allegations.

(Continued on LIC9099-C page)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2025

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 4

Control Number 28-AS-20250415103132

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DREAM CARE HOME LLC	FACILITY NUMBER: 198602967
	VISIT DATE: 09/13/2025

NARRATIVE

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Allegation: Staff did not assist resident with obtaining medical care.
It is alleged that staff did not take R1 to their follow-up appointment regarding an injury to their hand. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated that R1 was provided with assistance to follow up visit, however, R1 would constantly refuse doctors visits unless their POA would take them. Interview with S1 revealed that R1 would not go to any doctors appointments without their POA and during the time of this needed follow up the POA was not in town and could not take R1 to the appointment, when staff would ask to take R1 to the doctor, R1 would refuse. LPA was provided with a Special Incident Report (SIR) that documented the refusals from 2/16/25-2/23/25, the POA was able to have R1 agree to go to the doctor and on 2/24/25 R1 was admitted to the hospital for treatment to their hand. Hospital Records also document admission date of 2/24/25 for treatment to hand injury. S1 and S2 stated they were unaware of any other follow up appointments as R1’s POA is the person who sets and transports R1 to all appointments as it was never communicated to staff about an upcoming or missed doctor appointment. LPA spoke with R1’s POA and it was confirmed that they set the appointments and transport R1 to their appointments without notifying staff as they use their own physician and not the physician the facility offers to residents. LPA interviewed 4 residents each resident denied the above allegation and stated that they are provided with medical care and assistance in making appointments if needed. Allegation is unsubstantiated.

Allegation: Staff do not allow resident to have confidential telephone calls.

It is alleged that when calls are made for R1 staff will put the phone on speaker to listen to the conversation. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated that when residents receive phone calls they are given the phone and typically the residents walk away, into their rooms, living room or porch, staff stated they do not follow to listen in on calls nor do they put the phone on speaker. LPA interviewed 4 residents and 4 out of 4 residents denied the above allegation and stated that they are given privacy when they have phone calls, R5 stated they have their own cell phone and are never asked to be in presence of staff when speaking on the phone. This allegation is unsubstantiated.

Allegation: Staff was mimicking the resident’s disability.

It is alleged that S1 was speaking with on the telephone regarding R1 and S1 mocked R1’s speech impediment. LPA interviewed 3 staff and each denied the above allegation stating that they have never mimicked or made fun of any of the residents or seen another staff do this. S1 stated they have never mocked residents. LPA interviewed 4 residents and each resident denied the above allegation, they stated they have never felt mocked, intimidated or made fun of by the staff and have never seen staff do that to another resident. This allegation is unsubstantiated. (Continued on the LIC9099-C page)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20250415103132

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DREAM CARE HOME LLC	FACILITY NUMBER: 198602967
	VISIT DATE: 09/13/2025

NARRATIVE

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Allegation: Staff fabricated what happened between two residents.
& Allegation: Resident was wrongfully evicted.
It is alleged that staff fabricated an altercation between R1 and another client in attempt to have R1 evicted and that on 4/14/2025, a 30-day eviction notice was received from the facility for R1 because of an altercation that R1 was a victim of. LPA interviewed 3 staff and each staff denied the above allegation and stated that leading to the eviction notice being provided to R1 there was a shift in behaviors where R1 was becoming more verbally aggressive towards staff and other residents. LPA was provided with SIRs and a copy of the Eviction Notice. Incident report dated 6/9/22 revealed that on 6/9/22 R1 entered the restroom while R4 was using it and got upset pushed R4 against the wall causing damage to the wall (photos of damage were also provided and observed). Incident report dated 2/15/25 revealed that on 2/15/25 R1 was upset and agitated with R4 as they were sitting in their seat in the living room, R1 became verbally aggressive and then physically assaulted R4 and R1 got injured in the process of hitting R4, emergency personnel were called and R1 was sent to the hospital. Staff stated that after the altercation R1 would continuously taunt, harass and be verbally aggressive to R4 and they became fearful for both residents safety, given R1s aggressive behaviors and violating the House Rules (Residents are to treat all residents, staff and guests with respect. Violent and harassing behaviors toward fellow residents and staff is considered a direct violation of House Rules) a 30-day eviction notice was provided on 4/11/25 with an effective date of May 11,2025, R1s last day in the facility was May 5, 2025 . LPA spoke with R1s POA and they stated that they are unsure if the reason for departure was because of the eviction and they were never forcefully removed from facility as they found a more suitable placement for R1. LPA interviewed 4 residents and each denied the above allegations and stated that they have never been issued an eviction notice, been threatened with eviction and do not feel staff would fabricate stories. Interviews with R2 and R3 revealed that R1 had history of instigating arguments with other residents and being verbally aggressive. R3 stated they had witnessed R1 being aggressive with R4 and R4 would not engage in the aggressive behavior. Both allegations are unsubstantiated.

(Continued on LIC9099-C page)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20250415103132

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DREAM CARE HOME LLC	FACILITY NUMBER: 198602967
	VISIT DATE: 09/13/2025

NARRATIVE

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Allegation: Staff blocked residents phone number, to prevent them from calling.
It is alleged that the facility intentionally blocked R1’s Power of Attorney (POA) phone number so that the POC cannot call and speak to R1. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated that they never blocked anyone’s number from the facility phone. S2 stated they believe R1 may have accidentally blocked the number while using it one day as R1 had a habit of pressing buttons on the cordless phone, there is a block button on the phone and its possible that it was mistaken for the end button as both are red. LPA inspected phone and observed 2 buttons in red, one that read end and the other that read block. S1 stated that although there was a mix up with the facility phone R1s POA was provided with the cellphone numbers for S1-S3 so that phone calls can be made with no issues until the problem was resolved. LPA interviewed 4 residents and 4 out of 4 residents denied the above allegation and stated that they have never had issues with staff blocking any of
their calls and have been able to use the facility phone with no issues. This allegation is unsubstantiated.

Based on statements and interviews conducted with staff/residents and review of resident files, there was not enough supportive evidence to concur with the reported allegations. Although the allegation 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 allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2025

LIC9099 (FAS) - (06/04)

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