306003751-9-18-2025-28-AS-DSIS-DNLR3B-20251120113937

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003751
Report Date: 09/18/2025
Date Signed: 09/18/2025 02:32:42 PM

Unsubstantiated

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
09/11/2025 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250911103442

FACILITY NAME:	CRJ HOME		FACILITY NUMBER:	306003751
ADMINISTRATOR:	CRISTINA SANTOS		FACILITY TYPE:	735
ADDRESS:	15044 BARNWALL STREET		TELEPHONE:	(714) 521-5956
CITY:	LA MIRADA	STATE: CA	ZIP CODE:	90638
CAPACITY:	6	CENSUS: 4	DATE:	09/18/2025
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Herminia "Amy" Baldevia - DSP		TIME COMPLETED:	02:47 PM

ALLEGATION(S):

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Staff handled resident roughly causing injury

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted an initial unannounced complaint visit to address the allegation listed above. LPA met with Herminia Baldevia, Direct Support Stafff for the facility, and explained the purpose of the visit. House Manager Loida Samonte arrived shortly thereafter.

The investigation consisted of the following: During the visit LPA toured the facility, interviewed Staff #1 - 3 (S1 - S3), Clients #1 - 4 (C1 - C4), and also obtained the Individual Program Plan (IPP), FACE Sheet, and physician's report for C1.

The investigation revealed the following: In regards to the allegation that "Staff handled resident rougly causing injury," it is alleged that S1 had either hit or handled C1 roughly at some point on 9/8/2025.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

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-20250911103442

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: CRJ HOME	FACILITY NUMBER: 306003751
	VISIT DATE: 09/18/2025

NARRATIVE

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During interviews with the clients, none of them corroborate the allegation. C1 did not indicate that S1 had ever hit them or handled them roughly. Another client interviewed that S1 had never put their hands on anyone and that S1 treats all of the clients in the home nicely. During interviews with the staff, none of them corroborated the allegation. S1 stated that they would never hit or abuse any of the clients in the facility. Another staff member interviewed stated that S1 has never hit any of the clients in the home, and they believe that it was a misunderstanding from a comment that C1 had made. LPA did not observe any injuries on C1's arms or head area.

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 are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report will be emailed to the administrator.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

LIC9099 (FAS) - (06/04)

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