198603273-5-14-2026-28-AS-DSIS-DUQQ3A-20260604114824

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603273
Report Date: 05/14/2026
Date Signed: 05/14/2026 12:40:27 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
05/08/2026 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260508162139

FACILITY NAME:	BRADBOURNE		FACILITY NUMBER:	198603273
ADMINISTRATOR:	BALLINGER, ASHLEY		FACILITY TYPE:	735
ADDRESS:	1332 BRADBOURNE		TELEPHONE:	(855) 302-3331
CITY:	DUARTE	STATE: CA	ZIP CODE:	91010
CAPACITY:	4	CENSUS: 4	DATE:	05/14/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Brian Grimes, DSP		TIME COMPLETED:	12:48 PM

ALLEGATION(S):

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Resident sustained an injury due to staff neglect or physical abuse

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted an initial unannounced 10-day complaint visit at the facility and met with Direct Support Professional (DSP), Brian Grimes and LPA explained the purpose of the visit. Administrator, Ashley Ballinger arrived shortly after and LPA explained the purpose of the visit.

The investigation consisted of the following: LPA interviewed the Administrator, and Client #1 (C1), Client #2 (2), Staff #2 (S2) to Staff #3 (S3). LPA interviewed Staff #1 (S1), Client #3 (C3) to Client #4 (C4) and Witness #1 (W1) to Witness #2 (W2) over the phone. LPA obtained copies from C1’s file such as Face Sheet, Client Notes, Special Incident Report and other pertinent documents. LPA also obtained the staff and client rosters.

The investigation revealed the following: in regards to the allegation "Resident sustained an injury due to staff neglect or physical abuse” it is alleged that during a Crisis Prevention Intervention (CPI) hold, S1 physically abused C1 causing C1 to sustain a bloody nose.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260508162139

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: BRADBOURNE	FACILITY NUMBER: 198603273
	VISIT DATE: 05/14/2026

NARRATIVE

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LPA interviewed the Administrator, and three (3) out of three (3) staff that denied the allegation stating that they have not observe S1 physically abuse C1 causing C1 to sustain a bloody nose nor have they physically abused C1. The Administrator, and three (3) out of three (3) staff stated that C1 would engage in physical aggression and self-injurious behaviors where C1 goes to the floor and C1 harms C1’s own face, nose, and arm. The Administrator and three (3) out of three (3) staff stated that when C1 engages in self-injurious behavior, staff conducts re-direct, de-escalate, and use blocking pads. LPA obtained a Special Incident Report (SIR) indicating a incident that occurred on 05/06/2026 in which resident engaged in self-injurious behavior and no medical treatment was necessary. LPA obtained an SIR indicating a incident that occurred on 05/09/2026 in which resident engaged in self-injurious behavior and no medical treatment was necessary. LPA obtained a SIR indicating a incident that occurred on 05/10/2026 in which indicated C1 engaged in physical aggression toward staff in which a CPI hold was conducted by two (2) staff for approximately one (1) minute and the hold was released once C1 stopped the aggressive behavior and no medical treatment was necessary. LPA interviewed C1 that denied the allegation stating that S1 did not physically abuse C1 and did not cause C1 to sustain a bloody nose. C1 stated that C1 was not physically abused by any other staff. C1 also stated that C1 did not witness any other client get physically abused by S1 or by any staff. LPA interviewed an additional three (3) clients that denied the allegation that stated that they have never witnessed S1 physically abuse C1 nor have they been physically abused by S1. LPA interviewed W1 and W2 that stated that C1 has a history of making false allegations, self-injurious behavior, emotional outbursts, and physical outbursts. Per Administrator, S1 was suspended as of 05/08/2026 pending investigation. LPA reviewed all documentation that C1 has a history of self-injurious behaviors, physical aggression, and false allegations about staff. LPA obtained the C1’s addendum indicating the facility staff are trained to conduct CPI holds. LPA reviewed records, Administrator, S1 to S3 has valid CPI training certificates. LPA also obtained staff in-service training dated 5/07/2026 covering Re-Direction and De-Escalation techniques. LPA also obtained staff in-service training dated 05/08/2026 covering CPI refresher. There is not enough sufficient evidence to substantiate.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was held and a copy of this report was provided to the Administrator, Ashley Ballinger.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026

LIC9099 (FAS) - (06/04)

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