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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006167
Report Date: 08/19/2025
Date Signed: 08/19/2025 06:21:44 PM

Unsubstantiated


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
08/12/2025 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250812152241
FACILITY NAME:LE-SA RESIDENTIAL CARE INCFACILITY NUMBER:
306006167
ADMINISTRATOR:LEE, JAMIEFACILITY TYPE:
735
ADDRESS:6622 MOUNT RIPLEY DRIVETELEPHONE:
(657) 214-2932
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:6CENSUS: 1DATE:
08/19/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Paula Stabler TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility did not allow client to leave or depart from the facility on weekends.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to begin the investigation into the complaint allegation listed above. LPA was greeted and granted entry by staff after introducing himself and stating the purpose of the visit. The complaint was investigation consisted of interviews and document review.

Regarding the allegation mentioned above, 0 of 5 individuals were unable to provide any corroborating information. During an interview with a Staff 1 (S1) it was discovered there were some safety concerns from staff about C1’s safety when leaving the facility that were addressed during a meeting for C1 that was attended by C1's service plan, and behaviiorist in July of 2025, safety parameters were put in place at the suggestion of C1’s coordinator and behavorist. According to staff 2 (S2), C1 has never been denied the opportunity to leave the facility, and C1 has not asked to leave the facility.

Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
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 2
Control Number 22-AS-20250812152241
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: LE-SA RESIDENTIAL CARE INC
FACILITY NUMBER: 306006167
VISIT DATE: 08/19/2025
NARRATIVE
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During interviews with two different witnesses, both expressed that they do not believe C1 has been restricted in anyway. Witness 1 (W1) stated this concern just came up during a July 2025 meeting. Witness 2 (W2) stated they do not believe C1’s has been restricted in any way. Witness 2 says everyone involved has the clients best interest in mind. W2 says that has been expressed to the client as well.

Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2