198603020-3-19-2026-28-AS-FFIS-DTMUSH-20260430155023

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603020
Report Date: 03/19/2026
Date Signed: 03/19/2026 07:59:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
03/11/2026 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260311113533

FACILITY NAME:	FMJVITACARE1 CORP		FACILITY NUMBER:	198603020
ADMINISTRATOR:	ALICE REYES		FACILITY TYPE:	735
ADDRESS:	2718 BLAKEMAN AVE		TELEPHONE:	(909) 641-7109
CITY:	ROWLAND HEIGHTS	STATE: CA	ZIP CODE:	91748
CAPACITY:	4	CENSUS: 4	DATE:	03/19/2026
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Ann Fernandez, House Manager		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff handled client in a rough manner.
Staff yell at client.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation on the allegations listed above. LPA met with Ann Fernandez and explained the purpose of the visit.

LPA obtained a copy of the staff and client roster, documents for Client #1, and interviewed staff and clients.

The investigation revealed the following:
Allegation – Staff handled the client in a rough manner. The allegation states that staff pushed Client #1’s head down while showering. LPA interviewed five (5) staff and two (2) clients. The alleged staff denied being rough with the client(s) while showering. Staff stated that Client #1 (C1) had lots of soap on the hair and asked the client to bow down to spray down all the soap.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

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 28-AS-20260311113533

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: FMJVITACARE1 CORP	FACILITY NUMBER: 198603020
	VISIT DATE: 03/19/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Staff assisted in lowering the head down by pressing down gently but denied using force. Other staff interviewed have observed no staff being rough with the clients. The administrator stated that the police conducted a visit to the facility, and the regional center is aware of the allegation. There were no concerns expressed by either party. LPA interviewed two (2) clients. Both clients stated that the staff are not rough with them and have not pushed their heads down roughly.

Allegation – Staff yell at client. It is alleged that staff yell or are being mean to the client. LPA interviewed five (5) staff for this allegation. None of the staff observed other staff yelling at the clients or being mean to them. Staff indicated they need to speak firmly with the clients at times, but not aggressively. LPA observed monthly in-service training on appropriate communication with the clients and ways to support them. LPA interviewed two (2) clients. Both clients stated that the staff do not yell at them or be mean to them.

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 allegations are UNSUBSTANTIATED.

An exit interview was conducted with A. Fernandez. A copy of this report, along with the appeal rights, was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2