198320425-1-14-2026-11-AS-UCOL-DRFTJV-20260219134659

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320425
Report Date: 01/14/2026
Date Signed: 01/14/2026 03:07:28 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/05/2026 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20260105121431

FACILITY NAME:	MONTOAK ONE		FACILITY NUMBER:	198320425
ADMINISTRATOR:	SHAHEEN, NAJMA		FACILITY TYPE:	740
ADDRESS:	1811 255TH STREET		TELEPHONE:	(310) 906-7713
CITY:	LOMITA	STATE: CA	ZIP CODE:	90717
CAPACITY:	6	CENSUS: 6	DATE:	01/14/2026
		UNANNOUNCED	TIME BEGAN:	09:22 AM
MET WITH:	ADMINISTRATOR NAJMA SHAHEEN		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not provide adequate care and supervision.
Staff do not communicate effectively with the residents.
Staff are not properly trained.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 01/14/2026 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Montoak One and was greeted by Administrator Najma Shaheen (S1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
The investigation consisted of the following: LPA Calderon interviewed Staff S1-S3, residents R1-R4. LPA Calderon obtained the following records: LIC500(dated 01/13/2026), Incident report (dated 12/20/2025,12/29/2025 and 01/04/2026), Physician report (dated 06/10/2024), training for licenses and staff for R1.
The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

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 3

Control Number 11-AS-20260105121431

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: MONTOAK ONE	FACILITY NUMBER: 198320425
	VISIT DATE: 01/14/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the Allegation: Staff do not provide adequate care and supervision.

This complaint alleged that the facility staff did not have staff working on 01/04/2026. LPA Calderon and S1 toured the facility. LPA Calderon noted resident coming and going. LPA Calderon noted 3 staff working and there were no negative interactions between staff and resident noted. Records review indicate the following: Reviewed incident report (dated 01/04/2026), report indicates that R1 complained of not feeling safe and called the police. Police arrived and did not find any issues. The Physician report (dated 06/10/2024) indicates that R1 has no cognitive health issues. LIC500 indicates that there is day, night and weekend staff working. Interviews indicate the following: S1 indicates that there are 2 staff that work in the front house and 1 staff that work in the back house. S1 indicates that S1 family live on the property for any issues. 3 out of 3 staff deny the allegation. R1 indicates that on weekends there are no staff living or working in the back house. R1 indicates that R1 did not feel safe and called the police. R1 indicates that the police did not find any staff working. R2 could not be interviewed as R2 moved out of the facility. 2 out of 4 residents deny the allegation.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff do not provide adequate care and supervision” is found to be UNSUBSTANTIATED.

Regarding the Allegation: Staff did not communicate effectively with the residents.

This complaint alleged that the facility staff did not speak English to residents in care. LPA Calderon toured the facility and noted staff speaking to residents in English. LPA Calderon did not notice any negative interactions between staff and residents. Records reviewed indicate the following: Reviewed incident report (dated 12/20/2025, 12/29/2025 and 01/04/2026), reports indicate that R1 had combative relations with staff. Interviews indicate the following: S1 indicates that R1 was combative with staff and advised S1 that R1 did not feel safe in the facility. S1 indicates that staff speak English and communicate with residents in care. S2-S3 interviewed with LPA Calderon in English. S2-S3 primary language is Spanish. 3 out of 3 staff deny the allegation. R1 indicates that the staff hired by the facility do not speak English and cannot communicate with residents in care. R2 cannot be interviewed due to R1 being moved to another facility. 2 out of 4 residents deny the allegation.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff do not communicate effectively with the residents” is found to be UNSUBSTANTIATED.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 11-AS-20260105121431

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: MONTOAK ONE	FACILITY NUMBER: 198320425
	VISIT DATE: 01/14/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the Allegation: Staff are not properly trained.

This complaint alleged that the facility staff do not train staff that work for the facility. Records reviewed indicate the following: Reviewed training certificate for S1-S3. Training provided to staff CPR/First aid, Medication assistance. Interviews indicate the following: S1 indicates that the facility provides training to staff on an annual basis. S1 indicates that all staff must have training to work for the facility. 3 out of 3 staff deny the allegation. R1 indicates that staff are not trained and should not take care of residents. R2 cannot be interviewed due to R1 being moved to another facility. 2 out of 4 residents deny the allegation.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff are not properly trained” is found to be UNSUBSTANTIATED.

No deficiencies cited during today's visit.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Najma Shaheen (S1).

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3