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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157202487
Report Date: 12/20/2021
Date Signed: 12/20/2021 04:57:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/20/2021 and conducted by Evaluator Malia Thao
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20210920111823
FACILITY NAME:MISSION WELLS, INC. SADDLEBACKFACILITY NUMBER:
157202487
ADMINISTRATOR:RAMIREZ, CLAUDIAFACILITY TYPE:
735
ADDRESS:7008 SADDLEBACK DR.TELEPHONE:
(661) 832-3400
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:5CENSUS: 4DATE:
12/20/2021
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Helen Houck, LicenseeTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff handled resident in a rough manner.
Facility staff restrained resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/20/21 at 11:35 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a complaint investigation. LPA explained reason for inspection and was granted entry. Licensee Helen Houck arrived a short time later.

LPA conducted interviews. During the course of the investigation, LPA conducted interviews, and reviewed records. Based on LPA’s interviews and records reviewed, there was not sufficient evidence to show facility staff handled resident in a rough manner or that facility staff restrained resident. The above allegations are unsubstantiated. The allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email and an electronic read receipt confirms receiving this document. Licensee was informed to select yes when prompted to send a read receipt. Facility Representative signature on file.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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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