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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330911397
Report Date: 08/04/2023
Date Signed: 09/11/2023 09:03:39 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/31/2023 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230731084049
FACILITY NAME:BETA RESIDENTIAL HOMEFACILITY NUMBER:
330911397
ADMINISTRATOR:MARTIN, MARYFACILITY TYPE:
735
ADDRESS:12035 HINSON STREETTELEPHONE:
(951) 243-1911
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:4CENSUS: 2DATE:
08/04/2023
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Bonifacio "Gene" Carlos, CaregiverTIME COMPLETED:
09:50 AM
ALLEGATION(S):
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Staff leaves residents unsupervised.
Staff is financially abusing residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to initiate an investigation into the allegations listed above. LPA met with Caregiver Gene Carlos and explained the purpose of today's visit.

LPA toured the facility and conducted interviews with staff. It was alleged that on 7/28/23, reported that around 9am there were no staff there at the facility. Interview with Staff 1 (S1) indicated that they were present on 7/28/2023 at the facility when clients were there and would never leave clients alone.

This is an amended version of the original report dated 8/4/2023, continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
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 18-AS-20230731084049
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BETA RESIDENTIAL HOME
FACILITY NUMBER: 330911397
VISIT DATE: 08/04/2023
NARRATIVE
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Interview with relevant party corroborated that staff were, in fact, at the facility and that clients were not alone. Interview statements obtained from all relevant parties did not validate nor prove the validity of the allegation. Thus, this allegation was found to be Unsubstantiated based on the evidence presented. Therefore, the Department was unable to dismiss the allegation.

It was then alleged that the clients were not getting their stipend from Social Security. LPA conducted interviews with staff, and relevant parties, and found that the weekly stipend was given by staff to clients on 07/28/2023. Due to the initial claim that clients had not received their weekly stipend, and through interview with relevant parties that contradicted the alleged occurrence, this allegation was found to be Unsubstantiated.

A finding of UNSUBSTANTIATED means that 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.

An exit interview was conducted where a copy of this report was discussed with and provided to Carlos.

This is an amended version of the original report dated 8/4/2023

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2