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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603322
Report Date: 11/18/2025
Date Signed: 11/18/2025 11:24:38 AM

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
11/14/2025 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251114132106
FACILITY NAME:HAVEN HOUSE RESIDENTIAL FACILITIES INCFACILITY NUMBER:
198603322
ADMINISTRATOR:CAGE, WANDAFACILITY TYPE:
735
ADDRESS:757 EDWIN AVETELEPHONE:
(909) 436-7423
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:4CENSUS: 4DATE:
11/18/2025
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Wanda CageTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Lack of care & supervision resulted in client inappropriately touching another client while in care
Staff did not prevent an altercation between clients
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted a visit to investigate the above allegations. LPA met John Alfred and discussed the purpose of today's visit. Horace Martin arrived at approximately 9:20 A.M.. Wanda Cage arrived at approximately 9:40 A.M

During this visit, LPA obtained a copy of the client and staff rosters, reviewed files for Client #1 (C-1) and Client #2 (C-2) and obtained relevant documentation, interviewed Client #2 (C-2) and Client #3 (C-3) and interviewed Staff #1 (S-1) through Staff #4 (S-4). LPA also obtained documentation from San Gabriel Pomona Regional Center pertaining to the above allegations which they found the allegations to be “unsubstantiated”. LPA was unable to interview Client #1 (C-1) as C-1 is non-verbal and Client #4 (C-4) as C-4 was unable to comprehend interview questions.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
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-20251114132106
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: HAVEN HOUSE RESIDENTIAL FACILITIES INC
FACILITY NUMBER: 198603322
VISIT DATE: 11/18/2025
NARRATIVE
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Allegation: Lack of care & supervision resulted in client inappropriately touching another client while in care. It has been alleged that on 11/04/25, it was reported that C-1 attempted to have sexual intercourse with C-2. Staff interviews revealed that C-2 has a history of fabricating stories when C-2 “becomes upset” or “does not get their way”. Per S-1, on 11/06/25, San Gabriel Pomona Regional Center Quality Assurance conducted a visit to this facility to investigate this allegation and that Pomona Police Department also came on 11/14/25. Interviewed staff indicated that they have not received any concerns/complaints from clients pertaining to this allegation. Client interviews revealed that staff provide adequate care and supervision. Per C-2, C-1 entered C-2’s room and touched C-2’s DVDs (C-2 was unable to recall date). Per C-2, C-1 touched/tapped C-2 on the shoulder and not in a sexual way (C-2 was unable to recall date). C-2 denies this allegation. Interviews do not corroborate this allegation.

Allegation: Staff did not prevent an altercation between clients. It has been alleged that C-1 pushed C-2 onto the floor in the dining room area and that C-1 punched C-2 in the stomach while staff were present (date unknown). Staff interviews revealed that C-1 has not pushed nor hit C-2. Interviewed staff indicated that they have not received any concerns/complaints pertaining to this matter. Interviewed staff indicated that C-2 has a history of fabricating stories. Client interviews revealed that C-1 has not pushed nor hit C-2. C-2 denies this allegation. Interviews do not corroborate this allegation.

Based on record review and interviews conducted the findings indicate, although the allegation(s) 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 conducted, appeal rights and a copy of this report were provided to Wanda Cage.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2