<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609628
Report Date: 10/03/2022
Date Signed: 10/03/2022 11:10:02 AM

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
02/09/2022 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20220209100650
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:
10/03/2022
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Jessica CruzTIME COMPLETED:
08:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide proper care and supervision to client in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Spaeth completed an unannounced visit and was greeted by house manager, Jessica Cruz. LPA stated the purpose of the visit was to investigate complaint, staff did not provide proper care and supervision to client in care. LPA conducted a tour of the facility and did not observe any health or safety issues. LPA reviewed resident's file at 7:40 until 7:50 am.

At 7:50 am LPA observed resident documentation which states resident is able to leave the facility unassisted. Also LPA previously interviewed the resident and staff who both confirmed resident requested to go to the mall. Resident also stated the staff member did not force R1 to leave the facility. Based upon interviews and review of the resident documents, this complaint is unsubstantiated.

Exit interview conducted, appeal rights discussed, and a copy of the report was given to the House Manager.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022
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