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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603553
Report Date: 10/07/2025
Date Signed: 10/07/2025 09:55:40 AM

Substantiated


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
07/17/2025 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250717092352
FACILITY NAME:TIMERS RESIDENTIAL CAREFACILITY NUMBER:
198603553
ADMINISTRATOR:WILLIAMS, SHAUNDAFACILITY TYPE:
740
ADDRESS:452 PEMBROOK AVENUETELEPHONE:
(424) 457-9771
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:6CENSUS: 3DATE:
10/07/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Shaunda WilliamsTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Personal Rights/Conduct inimical- S1's conduct poses a health and safety concern.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Elizabeth Irra and Nune Margaryan conducted a subsequent visit to deliver findings for the above allegation. LPA was allowed entry by Shaunda Williams (Administrator). LPAs discussed the purpose of today’s visit.

On 07/18/25, LPA Nune Margaryan conducted the initial visit. During this visit, LPA Margaryan conducted a tour of the living room, dining area, kitchen, outside of facility, common areas and resident rooms. The kitchen had sufficient perishable and non-perishable food. Resident rooms and common areas were properly furnished. LPA did not observe any signs of neglect, abuse or other immediate health and safety threats. LPA Margaryan requested copies of staff and resident roster along with other pertinent documentation.

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

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
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 3
Control Number 28-AS-20250717092352
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: TIMERS RESIDENTIAL CARE
FACILITY NUMBER: 198603553
VISIT DATE: 10/07/2025
NARRATIVE
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During this investigation, Michele Salant (Department of Social Services Community Care Licensing Investigation Branch) interviewed Individual #1 (I-1) through Individual #3 (I-3), Resident #1 (R-1) and Resident #2 (R-2), S1, obtained police reports from the Pomona Police Department, obtained video footage and photos of S1 pertaining to this incident, obtained a copy from the Pomona Courthouse.

Allegation: Personal Rights/Conduct inimical- S1's conduct poses a health and safety concern. It has been alleged that on 07/15/25, S-1 was involved in a physical altercation at a park with other individuals and was observed to use a baseball bat with the intent of hitting the individuals involved and also used a baseball bat to vandalized a vehicle. Interviews revealed that on 07/15/25, S1, was involved in a physical altercation with a group of individuals at a park. S1 confirmed participating in this fight. Reports and interviews revealed that S1 arrived at the park, instigated the fight, returned to their car and returned back to the park with a baseball bat and ski mask. Reports and interviews revealed that S1 was observed to be swinging the baseball bat with force towards the individuals in the fight and was observed to be intentionally vandalizing a vehicle with the baseball bat. Reports and interviews revealed that S1 fled the scene and was apprehended by Pomona Police Department shortly after. Reports revealed that S1 had the baseball bat on the back seat of their vehicle with glass still lodged on it and observed to have a ski mask as well. Reports, interviews and documentation corroborate this allegation.

This case may be referred to CCLD’s Legal Division. Such referral may result in the filing of administrative action before the Office of Administrative Law.

Deficiency cited. Refer to LIC 9099D.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

An exit interview was conducted. A copy of this report and appeals rights were provided to XXXXXX.

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

DATE: 10/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 28-AS-20250717092352
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: TIMERS RESIDENTIAL CARE
FACILITY NUMBER: 198603553
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
10/08/2025
Section Cited
HSC
1569.50(a)(3)
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(a) The department may deny an application for a license or may suspend or revoke a license issued under this chapter upon any of the following grounds and in the manner provided in this chapter: (3) Conduct that is inimical to the health, morals, welfare, or safety of eithr an individual in or receiving
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Licensee shall develop a written plan of correction to ensure compliance with Health and Safety Code 1569.50 (a)(3) and submit to LPA Irra by POC due date of 10/08/25.
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services from the facility or the people of the State of California. This standard is not met as evidence by: Evidence collected via interviews, records, video footage and photos corroborate the alleged incident that occurred at the park as noted on this report.
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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: Wei Siew Ho
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2025
LIC9099 (FAS) - (06/04)
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