366405847-6-17-2026-56-AS-KCLS-DWENW3-20260728104853

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366405847
Report Date: 06/17/2026
Date Signed: 06/17/2026 10:08:05 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2026 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20260610130709

FACILITY NAME:	HOWARD HOME		FACILITY NUMBER:	366405847
ADMINISTRATOR:	TOLENTINO, LILIAN MA.		FACILITY TYPE:	735
ADDRESS:	4361 HOWARD AVENUE		TELEPHONE:	(909) 627-2546
CITY:	MONTCLAIR	STATE: CA	ZIP CODE:	91763
CAPACITY:	6	CENSUS: 6	DATE:	06/17/2026
		UNANNOUNCED	TIME BEGAN:	05:45 AM
MET WITH:	Ferman Agrisole, Administrator		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff are sleeping on the client's bed.

Staff are not providing comfortable accommodations to the clients.

Staff are invading the clients privacy.

Staff are not providing care and supervision while on duty.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met Administrator Ferman Agrisole and explained the elements of the visit.

Allegations #1 - LPA Prieto toured the facility, with Inland Regional Staff (IRC), observed each resident's rooms to see that 3 of the 6 residents were sleeping alone in their beds. The remaining 3 resident's were dressed and prepared to attend Day Program. At the time of inspection, LPA Prieto observed five (5) staff at the facility cleaning and/or assisting residents at the home, none of which were sleeping in client beds.

Allegation #2 - Tour of the facility concluded that there is adequate level of comfortably at the home. Each resident has their own bed, with mattresses and linen. LPA also observed resident's sitting on sofas in the common area that appeared to be in working order. Residents were watching television, eating breakfast or viewing tablets during this inspection. Resident #4 (R4), was observed not having a box bed and was

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

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 56-AS-20260610130709

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: HOWARD HOME	FACILITY NUMBER: 366405847
	VISIT DATE: 06/17/2026

NARRATIVE

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explained that resident has had behavior that cause the box bed to break and in need of replacement. This behavior was documented. This did not impede resident's sleep or comfortably as the mattress lays in bedframe that also has a base.

Allegation #3 - At the time of inspection, LPA Prieto observed five (5) staff at the facility cleaning and/or assisting residents at the home. Staff were addressing these resident while awake. R4 and R6 were being assisted by staff, directly, as these resident's require one on one (1 on 1) care. LPA observed resident's who do not require 1 on 1 care afforded privacy while using the restroom or time watching television or on their tablets.

Allegation #4 - LPA Prieto observed five (5) staff at the facility cleaning and/or assisting residents at the home. Staff were addressing these resident while awake. R4 and R6 were being assisted by staff, directly, as these resident's require one on one (1 on 1) care. Staff were also observed cleaning, cooking and dispensing medication.

Based on the information obtained there is not enough evidence to substantiate the allegations made in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Administrator Agrisole and a copy of this report was left with the facility.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

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