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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006815
Report Date: 08/26/2026
Date Signed: 08/26/2026 11:49:19 AM

Unfounded


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
08/20/2026 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260820163401
FACILITY NAME:A PLACE LIKE HOME VIIFACILITY NUMBER:
306006815
ADMINISTRATOR:BEN, SHEILA MARIEFACILITY TYPE:
740
ADDRESS:13551 TAHOE STREETTELEPHONE:
(909) 894-6454
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:6CENSUS: 4DATE:
08/26/2026
UNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Administrators Maria Jasmin Avila and Licensee Sheila BenTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not meeting residents needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to initiate complaint investigation. LPA Tirre met with Administrator Maria Jasmin Avila and Licensee Sheila Ben. During the visit LPA toured the facility, conducted interviews with staff & residents and reviewed records.
Interviews were conducted with three of four residents and residents stated that their needs are being met at facility and that they are able to communicate their needs and concerns to staff if they have any. Resident interview and staff interviews confirmed that residents and responsible parties were active in paperwork completed at facility. Record review revealed that four resident’s (R1-R4) have family members listed as Power of Attorney and Health Directives. LPA observed, the Resident in question does not reside at facility and has never resided at facility.
Based on info gathered, the allegations are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or is without a reasonable basis.

An Exit interview conducted and a copy of this report was provided to the facility.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026
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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