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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609628
Report Date: 10/27/2021
Date Signed: 10/27/2021 12:47:28 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/07/2021 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20210607104249
FACILITY NAME:CORNERSTONE FACILITIES, LLCFACILITY NUMBER:
197609628
ADMINISTRATOR:ANDERSON MUNOZFACILITY TYPE:
735
ADDRESS:504 W AVE H13TELEPHONE:
(818) 687-3830
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:4CENSUS: 4DATE:
10/27/2021
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Latasha MoodyTIME COMPLETED:
10:05 AM
ALLEGATION(S):
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Resident does not have access to her mail.

Resident was not informed regarding a meeting with CCL.

Resident was afraid a resident at the facility filed a restraining order.
INVESTIGATION FINDINGS:
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LPA Spaeth conducted an unannounced visit at 9:15 am and was greeted by Caregiver, Latasha Moody. Upon arrival, LPA observed the COVID sign on the front door. LPA's temperature was taken and was asked the COVID questions. Caregiver confirmed there are four residents in the facility and the residents were just getting up. LPA stated the purpose of the visit was regarding the above mentioned allegations.

On October 25, 2021 at 2:33 pm, LPA spoke to resident by phone regarding the receipt of mail. Resident stated received mail from Administrator, Therefore the allegation, resident does not have access to mail is unsubstantiated.

In regard to allegation, Resident was not informed regarding a meeting with CCL. On October 25, 2021, LPA asked R1 about the allegation receiving a text from a staff about meeting CCL. R1 stated does not remember
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
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 2
Control Number 31-AS-20210607104249
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CORNERSTONE FACILITIES, LLC
FACILITY NUMBER: 197609628
VISIT DATE: 10/27/2021
NARRATIVE
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receiving the text from any staff members at the facility. R1 stated cannot remember why this was stated when called CCL. R1 stated did not get a text from the Administrator regarding a meeting with CCL. LPA Spaeth spoke to Administrator on October 25, 2021 at 3:30 pm and Administrator stated did not text R1 regarding a meeting with CCL. Therefore the allegation, Resident was not informed regarding a meeting with CCL is unsubstantiated.

LPA Spaeth spoke to R1 on October 25, 2021 regarding allegation resident was afraid a resident at the facility filed a restraining order. R1 stated was afraid that R2 did file a restraining order against R1. On October 25, 2021, LPA asked Administrator if a restraining order had been filed by R2 against R1. Administrator stated the order was never filed in court. Therefore the allegation is unsubstantiated.

Exit interview was conducted, appeal rights discussed, and a copy of the report was provided to Caregiver.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2