306003751-10-13-2025-28-AS-DSIS-DNLSXD-20251120131545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003751
Report Date: 10/13/2025
Date Signed: 10/13/2025 11:31:54 AM

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
10/06/2025 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20251006135332

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:	10/13/2025
		UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Herminia "Amy" Baldevia - DSP		TIME COMPLETED:	11:55 AM

ALLEGATION(S):

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Staff hit a client
Staff yelled at a client

INVESTIGATION FINDINGS:

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Licensnig Program Analyst (LPA) Erik Zaragoza conducted an unannounced initial complaint visit to address the allegations listed above. LPA met with Herminia Baldevia, Direct Support Staff for the facility, and explained the purpose of the visit. Administrator Martha Losoya was notified of the visit by phone call.

The investigation consisted of the following: LPA obtained the staff and client rosters, interviewed Clients #1 - 4 (C1 - C4), Staff #1 - 3 (S1 - S3), and Witness #1 (W1).

The investigation revealed the following: In regards to the allegation that "Staff hit a client," it is alleged that S1 had hit C1 in the back of the head on 10/2/2025 with and open hand.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Erik Zaragoza
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025

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-20251006135332

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: 10/13/2025

NARRATIVE

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During interviews with the clients, none of them corroborated the allegation. C1 stated that none of the staff of the home put their hands on her or hit her. All other clients stated that they have never witnessed the staff of the facility hit any of the clients of the home. During interviews with the staff, none of them corroborated the allegation. S1 stated that they never hit C1, and that the facility has a zero tolerance policy for physical abuse. Another staff interviewed stated that none of the other staff have hit C1 in the past.

In regards to the allegation that "Staff yelled at client," it is alleged that S1 and S2 had yelled at C1 and called C1 a liar. During interviews with the clients, none of them corroborated the allegation. C1 stated that she has never been yelled by any of the staff in the facility. The other clients interviewed stated they have never witnessed staff yelling or raising their voice at C1. During interviews with the staff, none of them corroborated the allegation. S1 stated that during this incident on 10/2/2025, they were redirecting C1 firmly but did not yell at her. S2 also stated they did not redirect or raise their voice at C1, and were redirecting C1 during the incident.

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: 10/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025

LIC9099 (FAS) - (06/04)

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