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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603035
Report Date: 10/13/2025
Date Signed: 10/13/2025 01:35:53 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
10/10/2025 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251010094410
FACILITY NAME:PUENTE HOMEFACILITY NUMBER:
198603035
ADMINISTRATOR:MELISSA VAZQUEZFACILITY TYPE:
737
ADDRESS:1423 E PUENTE AVETELEPHONE:
(626) 331-6331
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:4CENSUS: 4DATE:
10/13/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Matthew Alabi - Asst. Administrator
Hannah Ortega - Interim Administrator		TIME COMPLETED:
01:35 PM
ALLEGATION(S):
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Due to lack of supervision, resident threatens/is aggressive to another resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced complaint visit regarding the above stated allegation. LPA met with Matthew Alabi, Asst. Administrator and explained the purpose of the visit. At 12:30pm, Hannah Ortega, Interim Administrator arrived and assisted LPA with the investigation.

The investigation consisted of the following: LPA conducted a tour of the physical plant, obtained copy of the Client & Staff Rosters, Staff weekly schedule, Staff training about clients behavior and aggression, Client #1 (C1) - Client #2 (C2) files such as; Identification & Emergency information (Face sheet), Physician’s report, Individual Behavioral Service Plan (IBSP), Individual Program Plan (IPP), Functional Capabilities Assessment, Shift to Shift notes (Oct 2025) and Incident reports (Oct 2025). LPA interviewed Staff #1 (S1) - Staff #4 (S4), Client #2 (C2), Service Coordinator (SC) at San Gabriel Pomona Regional Center and Family member #1 (FM1). Client #1 (C1) was admitted in the hospital, and Client #3 (C3) - Client #4 (C4) were at the day program, therefore not interviewed. ***CONTINUED ON LIC9099-C*****
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
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 2
Control Number 28-AS-20251010094410
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: 10/13/2025
NARRATIVE
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The investigation revealed the following:

Allegation: "Due to lack of supervision, resident threatens/is aggressive to another resident." It is alleged that C1 is scared of C2 because C2 has threatened to hit C1 with a belt, has been aggressive toward C1 and bothers C1 frequently. (4) out of (4) staff interviewed stated that C1 and C2 have 1:1 care and 2:1 care when out in the community. All staff interviewed stated that on Sun., 10/05/2025, an incident happened where without provocation, C2 came out of her room with a belt and attempted to hit C1 while C1 was coming out of the room. Staff interviewed stated that  no one was hurt since staff responded quickly by preventing C2 from striking C1 and were able to de-escalate the situation. All staff interviewed indicated that staffing is sufficient to provide proper supervision and care to the clients. S1 indicated that additional care plans for the clients, such as more activities and medication evaluations are being reviewed to prevent future client to client conflicts. Staff confirmed they received required training and know how to handle clients' aggression. Interview with C2 stated that C1 was yelling all night which caused C2 not to get sleep and was annoyed by it. C2 indicated that they are satisfied with the care level and supervision they receive. Documents reviewed revealed that (5) staff plus the Administrator/Asst. Administrator are scheduled to work per shift, and (3) staff work during the night shift. Reviewed documents also show that staff received the required training. Service Coordinator at the Regional Center confirmed that there is no ongoing investigation about this allegation. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with clients and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the 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 conducted and a copy of this report was provided to Hannah Ortega, Interim Administrator.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC9099 (FAS) - (06/04)
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