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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003739
Report Date: 05/14/2026
Date Signed: 05/14/2026 02:21:59 PM

Substantiated


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
04/23/2026 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260423121650
FACILITY NAME:JAIRE HOME VIFACILITY NUMBER:
306003739
ADMINISTRATOR:ARIEL RESURRECCIONFACILITY TYPE:
735
ADDRESS:9223 FLORA VISTA STREETTELEPHONE:
(562) 920-5758
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:4CENSUS: 4DATE:
05/14/2026
UNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Sheila Masuecos - House Lead TIME COMPLETED:
02:35 PM
ALLEGATION(S):
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Staff inappropriately handled residents in care.
INVESTIGATION FINDINGS:
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**This report supersedes original report dated 5/8/26. Reason for superseding is to change regulation used. Findings remain the same**
Licensing Program Analyst (LPA) Tena Herrera conducted a subsequent unannounced complaint visit to investigate the above allegation. LPA met with House Lead Sheila Masuecos and explained the purpose of today's visit.
The investigation consisted of the following:
On 4/30/26 LPA conducted initial 10-day visit and reviewed S1’s file, obtained copies of staff schedule, staff charting notes for Client #1 (C1) from 3/27/26 - 4/30/26, and obtained phone numbers for 3 staff. LPA interviewed 4 Staff and 1 Client (C2). On 5/7/26 LPA interviewed 4 Staff, 1 Client (C1) and 1 Witness (W1) via phone calls and reviewed the Special Incident Report (SIR) that was provided to the department. During todays visit LPA reviewed and obtained copy of C1’s Individual Program Plan (IPP), interviewed C1's Regional Center Service Coordinator (W2) and delivered findings on the reported allegation.
(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
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)
Page: 1 of 3
Control Number 28-AS-20260423121650
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: JAIRE HOME VI
FACILITY NUMBER: 306003739
VISIT DATE: 05/14/2026
NARRATIVE
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The Investigation revealed the following:
Allegation: Staff inappropriately handled residents in care.
It is alleged that on either 3/29/2026 or 4/5/2026 S1 got upset with C1 and grabbed C1 inappropriately by the wrist. LPA interviewed 8 staff and 5 staff denied the allegation. Interview with S6 revealed they were present during the incident, S6 was cooking at the time and witnessed C1 leave the kitchen/dining area S1 followed, shortly after they heard S1 call for assistance and upon arriving to the living room S6 saw both S1 and C1 on the floor, S1 was on top of C1 and holding C1 by the wrist with C1’s arm behind their back and C1 was pulling on S1’s shirt. S6 stated that they told S1 to stop and get off C1 as they can hurt them and S1 removed their grip on C1’s wrist and removed their shirt to get away from C1 as C1 would not let go of S1’s shirt. C1 then went to their room and the behavior de-escalated. Interview with S1 revealed that the incident occurred, S1 stated that they are aware they may have not followed the proper protocol and did not restrain C1 in attempt to harm them but in attempt to keep C1 from hitting and scratching them. S1 also stated that they ran after C1 when C1 left the dining room and knew C1 was already experiencing a behavioral episode, S1 stated that this may have been what caused C1’s behavior to escalate, regrets following C1 to their room and should have allowed C1 time to calm down. LPA interviewed 1 witness and they confirmed that there was an incident that occurred but could not get much detail from C1 as C1 has a hard time communicating the exact events of the incident. W1 stated that C1 has aggressive behaviors that begin mild and will decrease when given space, however, if C1 is being followed or feels threatened the behaviors will increase. W1 confirmed that a body check was performed on 4/30/26 and there was no evidence of redness or bruising on C1. LPA reviewed SIR that the department received on 4/28/26 stating that on 4/23/26 a Sheriff arrived at facility to speak with both C1 and S1 and that S1 would be released from duties for further investigation. LPA interviewed 2 clients and both denied the allegation, C1 stated they do not know who S1 is and that staff have never mistreated or handled them inappropriately. LPA reviewed C1’s IPP and Behavioral Service Plan, both indicated that C1 experiences aggressive behaviors that last up to 10 minutes, soothing C1 and providing support are things that can be done to decrease the behaviors. There was nothing noted in the IPP or the Behavioral Service Plan that explained the proper protocol on how to de-escalate C1’s aggressive behavior. Interviews with 8 staff and 2 witnesses confirmed that when a client is experiencing a behavioral episode like this, time and space should be provided so the clients can calm down.

Based on LPAs interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 6, Subchapter 1, are being cited on the attached LIC 9099D. Exit interview held, and a copy of this report and appeal rights were provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
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)
Page: 3 of 3
Control Number 28-AS-20260423121650
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: JAIRE HOME VI
FACILITY NUMBER: 306003739
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2026
Section Cited
CCR
85102(a)(7)
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85102 Emergency Intervention Prohibitions (a) The following emergency interventions shall not be used on a client: (7) Manual restraint with the person’s hands held or restrained behind the person's back; This requirement was not met as evidence by:

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Administrator/Licensee to schedule a retraining for all staff on proper use of restraint/de-escalating techniques and clients personal rights, the scheduled date for this training is to be provided to LPA via email by POC Due date of 5/9/26. This training must be held no later than 5/22/26, a copy of the training log with participant signatures, and copy of the training materials is to be emailed to LPA by end of day 5/22/26. (tena.herrera@dss.ca.gov)
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Based on interviews with S1 and S6, it was confirmed that S1 followed C1 while C1 was experiencing a behavioral episode. S1 and C1 were on the floor and S1 was holding C1 down with one arm on their back and holding C1’s wrist. There were no injuries sustained, however, this was an improper method of deescalation technique as interviews with 8 staff and 2 witnesses stated following a client (to their room) while they are experiencing a behavioral episode can cause behaviors to escalate and doesnt allow the client time and space to calm down, which poses an immediate health, safety or personal rights risk to persons in care.
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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: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3