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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800058
Report Date: 06/17/2021
Date Signed: 06/17/2021 11:56:28 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/11/2021 and conducted by Evaluator Stephanie Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210611163533
FACILITY NAME:A B CARING SENIOR LIVINGFACILITY NUMBER:
331800058
ADMINISTRATOR:CARRASCO, REBECCAFACILITY TYPE:
740
ADDRESS:1698 ALBERHILL STREETTELEPHONE:
(951) 928-0004
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:6CENSUS: 6DATE:
06/17/2021
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Rebecca CarrascoTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility water temperature is too hot.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Williams made an unannounced visit to the facility in order to initiate a complaint investigation into the above allegation. LPA met with Administrator, Rebecca Carrasco, and discussed the purpose of the visit. The investigation consisted of direct observation and interviews with staff.

LPA measured the hot water temperature dispensing from the facility's kitchen sink, which measured at 114 F. LPA also measured the hot water temperature dispensing from a common bathroom sink, which measured at 113 F. LPA interviewed Staff #1 (S1) who stated that the facility's hot water temperature was last checked at the beggining of May 2021 and it measured at 117 F. S1 stated that the hot water temperature is checked occasionally.

Based on evidence obtained during today’s visit, LPA has determined that the above allegation is UNSUBSTANTIATED; meaning that although the allegation may have happened or is valid, there is not a
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
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 18-AS-20210611163533
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: A B CARING SENIOR LIVING
FACILITY NUMBER: 331800058
VISIT DATE: 06/17/2021
NARRATIVE
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SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2