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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603035
Report Date: 05/18/2026
Date Signed: 05/18/2026 05:04:40 PM

Substantiated


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
04/16/2026 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260416160540
FACILITY NAME:PUENTE HOMEFACILITY NUMBER:
198603035
ADMINISTRATOR:PUALEILANI TATAFACILITY TYPE:
737
ADDRESS:1423 E PUENTE AVETELEPHONE:
(626) 331-6331
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:4CENSUS: 4DATE:
05/18/2026
UNANNOUNCEDTIME BEGAN:
02:07 PM
MET WITH:Hannah Ortega – Administrator TIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff are not adequately trained
Staff did not dispense medication to residents as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint visit regarding the above stated allegations. LPA met with Hannah Ortega and explained the reason for the visit.

Investigation consisted of the following:

On 4/17/26 LPA B.Pena conducted the initial visit and reviewed/obtained a copy of the staff & client rosters, Staff schedule, San Gabriel Pomona Regional Center Corrective Action Plan (CAP), staff in service training logs, and interviewed 2 Staff.
During todays visit 5/18/26 LPA Herrera conducted Subsequent visit and obtained copies of In-Service CPI trainings, copy of Medication Training, Copy of February Medication Administration Record (MAR) for C1, reviewed 6 staff files, interviewed 3 Staff (S2, S11, S14), and delivered findings on the reported allegations.

(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
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 5
Control Number 28-AS-20260416160540
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: PUENTE HOME
FACILITY NUMBER: 198603035
VISIT DATE: 05/18/2026
NARRATIVE
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The investigation revealed the following:
Allegation: Staff are not adequately trained
It is alleged that it is alleged that the staff at the facility who hold a CPI training are not given the required yearly refresher training's. Per interview with S1 it was revealed that 30-minute monthly CPI training's are conducted for staff, however, during a visit from Regional Center it was observed that some staff did not sign the sign in sheet for the training and this implied that the staff did not complete their training. LPA reviewed the in-service sign in sheets for CPI Refreshers and observed that the following proof of completion was missing: Sign in Sheet dated 7/29/25, S3 and S4 missing their training; Sign in Sheet dated 8/27/25, S4-S8 missing their training; Sign in sheet dated 9/24/25, S4 missing their training; Sign in Sheet dated 10/16/25, S1,S3,S4,S7,S9 & S10 missing their training; Sign in Sheet dated 11/26/25, S10-S12 missing their training; Sign in sheet dated 12/30/25, S13 missing their training; Training's for January-April 2026 all staff have completed their required training. S1 confirmed that they are now offering 3 different classes each month to allow for all staff to attended and ensure they are maintaining the required training.

Allegation: Staff did not dispense medication to residents as prescribed


It is alleged that C1 ran out of medication and missed their routine evening medication on 2/26/26 and 2/27/26. LPA reviewed the Medication Administration Record (MAR) for C1 and observed that the medication in question was signed for by staff, after reviewing the internal notes it was documented that C1 was not administered their routine medication as medication was not at facility and C1 refused to wait for emergency medication to be prescribed to them at urgent care. LPA interviewed 3 staff and 2 of the 3 confirmed the allegation, S1 stated that the medication was not refilled in error, it was observed to be out on a Friday and due to the weekend and pharmacy being closed they were not able to get the medication refilled until the following Monday. S1 stated they attempted to take C1 to urgent care in effort to get an emergency replacement medication refilled, however, C1 was non-compliant and refused to wait to be seen for the medication.

Based on LPAs observations, interviews which were conducted, and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 6 are being cited on the attached LIC 9099D. Exit interview held, and a copy of this report and appeal rights were provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20260416160540
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: PUENTE HOME
FACILITY NUMBER: 198603035
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/19/2026
Section Cited
CCR
80075(b)
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80075 Health Related Services (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement was not met as evidence by:
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Per Administrator Medication training with pharmacist was completed on 3/18/26 and provided LPA with a copy of the In-Service Sign in sheet with participant signatures. POC is now cleared and a copy of the POC Clearance Letter will be provided prior to the end of visit.
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LPA conducted MAR and obseved that on 2/26/26 and 2/27/26, the note on the MAR stated that C1 was not administered their routine medication as medication was not at facility and C1 refused to wait for emergency medication to be prescribed to them at urgent care. Staff interviews confirmed this allegation as well, this poses an immediate health, safety or personal rights risk to persons in care.
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Type B
05/19/2026
Section Cited
CCR
85165(b)(3)
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85165 Emergency Intervention Staff Training (b) Staff who use, participate in, approve or provide visual checks of manual restraint or seclusion, shall have a minimum of sixteen hours of emergency intervention training and be certified for having successfully completed the training. (3) Staff shall have a minimum of 6 hours of annual refresher training following the initial training certification. The provisions specified in Section 85165 (c)-(e) and, (g) shall also apply to this training. This requirement was not met as evidence by:
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Per Administrator the facility has now changed the procedure on the in-service monthly 30 minute refresher training that is provided to staff, now offering them 3 dates a month (instead of 1) where they can sign up for the refresher course so that it is more easily accessible for staff and ensures each staff receive the required training. Copy of this plan was provided to LPA during todays visit along with proof of each employee's refresher training completion from Jan-April 2026, POC is now cleared and a copy of the POC Clearance Letter will be provided prior to the end of visit.
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During review of training LPA observed that the refresher training from 7/25-12/25 had several staff (see 9099-C) that missed the required 30minute monthly training completed, which indicates that the staff did not complete the required training, this was also confirmed during staff interviews, which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
04/16/2026 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260416160540

FACILITY NAME:PUENTE HOMEFACILITY NUMBER:
198603035
ADMINISTRATOR:PUALEILANI TATAFACILITY TYPE:
737
ADDRESS:1423 E PUENTE AVETELEPHONE:
(626) 331-6331
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:4CENSUS: 4DATE:
05/18/2026
UNANNOUNCEDTIME BEGAN:
02:07 PM
MET WITH:Hannah Ortega – Administrator TIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not maintain accurate facility records
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint visit regarding the above stated allegations. LPA met with Hannah Ortega and explained the reason for the visit.

Investigation consisted of the following:
On 4/17/26 LPA B.Pena conducted the initial visit and reviewed/obtained a copy of the staff & client rosters, Staff schedule, San Gabriel Pomona Regional Center Corrective Action Plan (CAP), staff in service training logs, and interviewed 2 Staff.
During todays visit 5/18/26 LPA Herrera conducted Subsequent visit and obtained copies of In-Service CPI trainings, copy of Medication Training, Copy of February Medication Administration Record (MAR) for C1, reviewed 6 staff files and interviewed 3 Staff (S2, S11, S14)

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20260416160540
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: PUENTE HOME
FACILITY NUMBER: 198603035
VISIT DATE: 05/18/2026
NARRATIVE
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The investigation revealed the following:

Allegation: Staff do not maintain accurate facility records


It is alleged that staff files are missing their proof of training on medication and competency to assist the clients in care. LPA reviewed 6 staff files during todays visit, each staff file reviewed assist with medication, each file had the required medication training documented within their files. Additionally, each staff had their competency trainings that were completed 3/2026. LPA interviewed S1 and staff stated that staff files are maintained accurately, however, during the visit with regional center there was one staff that did not have the training documented in their file, but the training was completed.

Based on statements and interviews conducted with staff, review of staff files, and facility file records, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is 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: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5