198603273-5-28-2026-28-AS-DSIS-DVYNS5-20260714104234

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603273
Report Date: 05/28/2026
Date Signed: 05/28/2026 03:16:19 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
05/20/2026 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260520155949

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:	05/28/2026
		UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Ashley Ballinger, Administrator		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Staff handled resident in a rough manner resulting in injury
Staff did not obtain medical care for resident in a timely manner

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 Staff #4 (S4) and Staff #5 (S5). LPA interviewed Staff #1 (S1), Staff #2 (S2), Client #2 (C2), Client #3 (C3), Client #4 (C4), and Witness #1 (W1) over the phone. LPA attempted to interview Client #1 (C1) over the phone but LPA was unable to interview C1 since C1 declined to be interviewed. LPA obtained copies from C1’s file such as Face Sheet, Hospital Medical Notes, Special Incident Report and other pertinent documents. LPA also obtained the staff and client rosters.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026

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-20260520155949

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: 05/28/2026

NARRATIVE

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The investigation revealed the following: in regards to the allegation "Staff handled resident in a rough manner resulting in injury.” It is alleged that on 05/18/2026 C1 became upset and was restrained by staff and hit C1’s head on the ground resulting in a bump on the right side of C1’s head. LPA interviewed the Administrator, and two (2) out of four (4) staff that denied the allegation stating that on 05/18/2026, C1 engaged in self-injurious behavior sustaining in a bloody nose. Administrator and two (2) out of four (4) staff also stated that on 05/18/2026 the staff engaged two (2) person CPI (Crisis Prevention Intervention) hold for four (4) minutes and released every thirty seconds which did not result in an injury. LPA interviewed an additional two (2) staff that denied the allegation stating that they have not handled C1 or any clients in a rough manner resulting in an injury and did not witness any staff handle C1 or any clients in a rough manner. The Administrator, and four (4) out of four (4) 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 head. The Administrator and four (4) out of four (4) staff stated that when C1 engages in self-injurious behavior, staff conducts re-direct, de-escalate, and use blocking pads. The Administrator, and four (4) out of four (4) staff also stated that C1 engages in property damage, self-injurious behavior, and makes false allegations about staff. LPA obtained a SIR (Special Incident Report) indicating a incident that occurred on 05/18/2026 in which indicated C1 engaged in emotional outbursts and physical aggression toward staff in which staff intervened utilizing verbal redirection, approved blocking techniques, separation of peers to maintain safety, and a CPI hold was conducted by two (2) staff for approximately four (4) minutes and the hold was released every thirty seconds and C1 also engaged in self-injurious behavior and attempts to injure C1’s nose and face and makes false allegations about staff hurting C1. SIR also indicated that law enforcement arrived on 05/18/2026 and C1 was transported to the hospital on a 5150 hold on 05/18/2026. LPA attempted to interview C1 over the phone but LPA was unable to interview since C1 declined to be interviewed. LPA interviewed W1 that stated that C1 would engage in self-injurious behavior, physical aggression, and make allegations about staff. W1 also stated that the staff are properly trained in CPI procedures. LPA interviewed an additional three (3) clients that stated that they have not witnessed on 05/18/2026, C1 get restrained by staff and did not witness C1’s head hit the ground that caused a bump on C1’s head. However, one (1) of those clients stated witnessing C1 hitting a staff member and also stated the police took C1 away from the home on 05/18/2026. Those three (3) clients also stated that they have not been treated by staff in a rough manner and have not witnessed any other clients get treated by staff in a rough manner. LPA reviewed all documentation that C1 has a history of self-injurious behaviors, physical aggression, and false allegations about staff. [Continue to LIC9099-C]

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20260520155949

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: 05/28/2026

NARRATIVE

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LPA obtained the C1’s addendum indicating the facility staff are trained to conduct CPI holds. LPA reviewed records, Administrator, S1 to S4 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.

Allegation: “Staff did not obtain medical care for resident in a timely manner.” It is alleged that on 05/18/2026, C1 had a headache after hitting C1’s head on the ground from being restrained by staff for which staff did not provide medication or treatment. LPA interviewed the Administrator, and two (2) staff denied the allegation stating that on 05/18/2026, C1 did not report to staff of having a headache and C1 did not request medication or treatment. However, per Administrator and two (2) staff, on 05/18/2026, C1 was having a physical aggression, verbal outburst, self-injurious behavior, and made false allegations about staff. The Administrator and two (2) staff stated that on 05/18/2026, C1 engaged in self-injurious behavior in which C1 hit C1’s own the face and nose area causing a bloody nose. The Administrator and two (2) staff stated the staff immediately treated the bloody nose and contacted 9-1-1 shortly after in which police and paramedics arrived. Per Administrator and two (2) staff on 05/18/2026, C1 was transported to the hospital on a 5150 hold. LPA interviewed an additional two (2) staff that denied the allegation stating that staff provides medical care in a timely manner. LPA obtained a SIR (Special Incident Report) indicating a incident that occurred on 05/18/2026 in which indicated C1 engaged in emotional outburst, physical aggression toward staff in which a CPI hold was conducted by two (2) staff for approximately four (4) minutes and the hold was released every thirty seconds and C1 also engaged in self-injurious behavior and attempts to injure C1’s nose and face. SIR also indicated that law enforcement arrived on 05/18/2026 and C1 was transported to the hospital on a 5150 hold on 05/18/2026. LPA reviewed medical hospital notes indicating C1 was admitted to the hospital on 05/18/2026 where CT scans were conducted on C1 which had no result of injuries. Per hospital medical notes, C1 was discharged and transported back to the facility on 05/19/2026. LPA attempted to interview C1 over the phone but was unable to interview since C1 declined to be interviewed. LPA interviewed an additional three (3) clients that stated they cannot recall on 05/18/2026 regarding C1 not receiving medical care in a timely manner. However, those three (3) clients stated that they are provided medical care by the staff in a timely manner. LPA reviewed C1’s eMAR (Electronic Medication Administration Record) and confirmed with the Administrator that C1 took all prescribed medications and C1 did not request PRN (as needed) medications to the staff on 05/18/2026. [Continue to LIC9099-C]

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20260520155949

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: 05/28/2026

NARRATIVE

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LPA reviewed all documentation that C1 has a history of self-injurious behaviors, physical aggression, and false allegations about staff. LPA reviewed records, Administrator, S1 to S4 has valid First Aid/CPR/AED training in file. LPA also obtained staff in-service training dated 02/09/2026 covering Health and Safety When There’s An Injury. There’s 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: 05/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4