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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603021
Report Date: 01/10/2026
Date Signed: 01/10/2026 01:15:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
10/17/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251017122852
FACILITY NAME:FAMILY HOME LLCFACILITY NUMBER:
198603021
ADMINISTRATOR:VILLALVA, JOEL HFACILITY TYPE:
740
ADDRESS:1629 CALLE CIERVOTELEPHONE:
(626) 354-0265
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:6CENSUS: 5DATE:
01/10/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Caregiver Agieh DulayTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Licensee did not comply with change of ownership requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted a subsequent complaint investigation visit on 01/10/2026 regarding the above allegation. During today’s visit LPA Ramirez was greeted by Caregiver Agieh Dulay and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff#1 – 6 interviews (S1 – S6), Resident#1-3 (R1 - R3), Interview with R1 and R5’s family, copy of disclosure regarding Real Estate Agency Relationship dated 05/22/2025, copy of admission agreement, copies of physician’s report for residents#1-5 (R1- R5), copies of medication administration record (MAR) October 2025 for R1 & R4, copy of Unusual Incident/Injury Report (LIC 624) for R1 & R5, and physical plant tour.

SEE 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2026
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 5
Control Number 28-AS-20251017122852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: FAMILY HOME LLC
FACILITY NUMBER: 198603021
VISIT DATE: 01/10/2026
NARRATIVE
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The investigation revealed the following: regarding the allegation “Licensee did not comply with change of ownership requirements.” It is alleged that the licensee did not comply with change of ownership requirements. Six (6) out of the six (6) staff interviewed corroborated this allegation. Three (3) out of the three (3) residents interviewed corroborated this allegation. Interview with resident#1 (R1) and resident#5 (R5) family corroborated this allegation. Interview with S1 revealed on or around May 2025, S1 sold the facility business to S2, and a contract was signed and enforced. S1 revealed that they did not inform this licensing agency prior to the sale or after the sale, nor did they inform their residents or family in writing regarding the sale of the facility. Interview with S2 revealed that S1 sold the facility business to them in May of 2025. During record review, LPA Ramirez reviewed copy of disclosure regarding Real Estate Agency Relationship dated 05/22/2025, which documents the sale of Family Home LLC from S1 to S2 and a close of escrow date of 06/01/2025. Per Title 22, Division 6, Chapter 8, Article 02- Transferability of License 87109(b)- The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least thirty (30) days prior to the transfer of the property or business, or at the time that a bona fide offer is made, whichever period is longer, as specified in Health and Safety Code Section 1569.191. Based on interviews, and records reviewed the licensee did not comply with change of ownership requirements, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

One (1) deficiency was issued. Exit interview was conducted. A copy of this report, 809-D and appeals rights was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20251017122852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: FAMILY HOME LLC
FACILITY NUMBER: 198603021
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2026
Section Cited
CCR
87109(b)
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The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing as soon as possible and in all cases at least thirty (30) days prior to the transfer of the property or business, or at the time that a bona fide offer is made, whichever period is longer.
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Licensee will submit a change of ownership application to central application bureau by 01/16/2026 and send proof to LPA via email.
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 This requirement was not met as evidenced by: intervews conducted and review of sale contract dated 5/22/25 which revealed the sale of Family LLC to S2 without notifying this agency first and it's residents prior to sale. This poses a potential risk to the health, safety, or personal rights of 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: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
10/17/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251017122852

FACILITY NAME:FAMILY HOME LLCFACILITY NUMBER:
198603021
ADMINISTRATOR:VILLALVA, JOEL HFACILITY TYPE:
740
ADDRESS:1629 CALLE CIERVOTELEPHONE:
(626) 354-0265
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:6CENSUS: 5DATE:
01/10/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Caregiver Agieh DulayTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
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5
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9
Staff did not seek timely medical attention for residents.
Staff did not dispense medication to residents as prescribed.
Staff spoke to resident in an inappropriate manner.
Staff did not maintain adequate food supplies for residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted a subsequent complaint investigation visit on 01/10/2026 regarding the above allegation. During today’s visit LPA Ramirez was greeted by Caregiver Agieh Dulay and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff#1 – 6 interviews (S1 – S6), Resident#1-3 (R1 - R3), Interview with R1 and R5’s family, copy of disclosure regarding Real Estate Agency Relationship dated 05/22/2025, copy of admission agreement, copies of physician’s report for residents#1-5 (R1- R5), copies of medication administration record (MAR) October 2025 for R1 & R4, copy of Unusual Incident/Injury Report (LIC 624) for R1 & R5, and physical plant tour.

SEE 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20251017122852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: FAMILY HOME LLC
FACILITY NUMBER: 198603021
VISIT DATE: 01/10/2026
NARRATIVE
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The investigation revealed the following: regarding the allegation “Staff did not seek timely medical attention for residents.” It is alleged that that staff did not seek timely medical attention for residents. Five (5) out of six (6) staff interviewed denied this allegation. Three (3) out of three (3) residents interviewed denied this allegation. Interview with resident#1 (R1) and resident#5 (R5) family did not corroborate this allegation. Review of Unusual Incident/Injury Report (LIC 624) for R1 - R5 did not corroborate this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

“Staff did not dispense medication to residents as prescribed.” It is alleged that staff did not dispense medication to residents as prescribed. Five (5) out of six (6) staff interviewed denied this allegation. Three (3) out of three (3) residents interviewed denied this allegation. Interview with resident#1 (R1) and resident#5 (R5) family did not corroborate this allegation. On 10/24/25, LPA Ramirez reviewed medication administration record (MAR) October 2025 for R1 & R5 and compared physician medication orders to MAR and did not observe any discrepancies. Review of Unusual Incident/Injury Report (LIC 624) for R1 - R5 did not corroborate this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Staff spoke to resident in an inappropriate manner. It is alleged that staff spoke to a resident in an inappropriate manner. Five (5) out of six (6) staff interviewed denied this allegation. Three (3) out of three (3) residents interviewed denied this allegation. Interview with R1’s family revealed that R1 told their family that staff#5 (S5) had spoken “harshly” to R1. On 10/24/25, LPA Ramirez interviewed R1 and R1 denied that S5 or any staff spoke to them in an inappropriate manner. R1 revealed that staff at the facility “do good job, I do not have anything bad to say about anyone.” Interview with R5’s family did not corroborate this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Staff did not maintain adequate food supplies for residents. It is alleged that staff did not maintain adequate food supplies for residents. Five (5) out of six (6) staff interviewed denied this allegation. Three (3) out of three (3) residents interviewed denied this allegation. Interview with resident#1 (R1) and resident#5 (R5) family did not corroborate this allegation. During facility tour, LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. LPA Ramirez observed additional perishable foods in garage refrigerator. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies were cited. Exit interview was conducted. A copy of this report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5