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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800057
Report Date: 03/14/2025
Date Signed: 03/14/2025 03:24:34 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
03/07/2025 and conducted by Evaluator Raquel Hernandez
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250307154518
FACILITY NAME:LARK RESIDENTIAL HOMEFACILITY NUMBER:
331800057
ADMINISTRATOR:CASTRO, LUDYFACILITY TYPE:
735
ADDRESS:1008 MEADOWVIEW COURTTELEPHONE:
(951) 520-1070
CITY:CORONASTATE: CAZIP CODE:
92880
CAPACITY:5CENSUS: 4DATE:
03/14/2025
UNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Janet ThomasTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff physically abused client.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to investigate and deliver findings on the allegation listed above. LPA met with staff Janet Thomas and explained the purpose of the visit. The investigation consisted of staff interview, and client interviews.

For the allegation, Staff physically abused client.

LPA Hernandez conducted (2) client interviews. 1 out of the 2 clients stated staff has not physically abused them and have not witnessed them physically abuse any other clients in care. Client #1 (C1) stated they have anemia and is why they get bruises on their body. Additionally, C1 stated facility staff has touched them but was unable to say how or when this occurred. LPA Hernandez conducted (2) staff interviews. 2 out of the 2 staff stated facility staff does not physically abuse clients in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025
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 56-AS-20250307154518
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: LARK RESIDENTIAL HOME
FACILITY NUMBER: 331800057
VISIT DATE: 03/14/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on the evidence gathered during today’s investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Staff Janet Thomas.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2