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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005891
Report Date: 04/14/2026
Date Signed: 04/14/2026 09:57:07 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/13/2026 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260413161852
FACILITY NAME:NANTUCKET HOMEFACILITY NUMBER:
306005891
ADMINISTRATOR:MAFA SETIFACILITY TYPE:
737
ADDRESS:1051 NANTUCKET ST.TELEPHONE:
(562) 267-0102
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:3CENSUS: 2DATE:
04/14/2026
UNANNOUNCEDTIME BEGAN:
07:44 AM
MET WITH:LaQuwia WinstonTIME COMPLETED:
10:10 AM
ALLEGATION(S):
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The facility did not document that the administrator was on duty the required number of hours
Staff did not receive timely emergency intervention training
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegations. LPA met with Assistant Administrator (AA) LaQuwia Winston, discussed the purpose of the inspection, and explained the allegations.

The investigation into the allegations that the facility did not document that the administrator was on duty the required number of hours and staff did not receive timely emergency intervention training revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AA, and obtained and reviewed copies of the client roster, staff roster, and staff training records.

CONTINUED
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
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 4
Control Number 22-AS-20260413161852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: NANTUCKET HOME
FACILITY NUMBER: 306005891
VISIT DATE: 04/14/2026
NARRATIVE
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Regarding the allegation that the facility did not document that the administrator was on duty the required number of hours: it was alleged that the previous administrator, Staff #1 (S1), resigned on March 4, 2026, Staff #2 (S2) is the acting administrator until a permanent administrator is identified, and the facility does not have logs showing the administrator was on duty the required number of hours for February 2026 through March 2026. LPA inspected the facility, conducted health and safety checks on clients, and observed no health and safety issues. LPA interviewed AA who admitted the allegation, stating that S1 left on March 4, 2026, and S2 was not at the facility the required number of hours in March 2026.

Regarding the allegation that staff did not receive timely emergency intervention training: it was alleged that Staff #3 (S3), who was hired on February 2, 2026, did not complete their 16-hour emergency intervention training until March 13, 2026, and Staff #4 (S4), who was hired on April 7, 2025, did not complete their 16-hour emergency intervention training until May 8, 2025. LPA interviewed AA who admitted the allegation, stating that S3 and S4 did not complete their 16-hour emergency intervention training within their first months of employment. LPA reviewed staff training records which confirm that S3 and S4 completed their 16-hour emergency intervention training on March 14, 2026 and May 8, 2025, respectively.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegations mentioned above. The preponderance of evidence standard has been met; therefore, the above allegations are Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20260413161852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NANTUCKET HOME
FACILITY NUMBER: 306005891
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/12/2026
Section Cited
CCR
89965(f)
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9965 Personnel Requirements (f) Each Enhanced Behavioral Supports Home shall have an administrator on duty a minimum of 20 hours per week per facility to ensure the effective operation of the facility. This requirement was not met as evidenced by:
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Licensee stated they will ensure the administrator is on duty the required number of hours and submit logs as proof to LPA by POC due date.
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Based on admission, the licensee did not ensure the administrator was on duty a minimum of 20 hours per week in March 2026, which poses a potential safety risk to persons in care.
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Type B
05/12/2026
Section Cited
CCR
89965(i)
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89965 Personnel Requirements (i) In addition to any other required training, each direct care staff person shall have a minimum of 16 hours of emergency intervention training… This requirement was not met as evidenced by:
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Licensee stated they have updated their training protocols to ensure staff receive their 16-hour emergency intervention training timely and will submit the protocol to LPA by POC due date.
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Based on documents and admission, the licensee did not ensure S3 and S4 completed their 16-hour emergency intervention training timely before providing care, which poses a potential safety 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: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4