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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880571
Report Date: 07/16/2021
Date Signed: 07/16/2021 10:26:54 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
07/15/2021 and conducted by Evaluator Christine Le
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210715145003
FACILITY NAME:A DREAMLAND CARE VILLAFACILITY NUMBER:
331880571
ADMINISTRATOR:ROMEO LABASTIDAFACILITY TYPE:
740
ADDRESS:12029 DRESSAGE LNTELEPHONE:
(951) 751-5875
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:6CENSUS: 6DATE:
07/16/2021
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Romeo LabastidaTIME COMPLETED:
10:36 AM
ALLEGATION(S):
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Facility does not have appropriate number of bathrooms for residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Le conducted an unannounced visit to the facility to investigate the above allegation. LPA met with administrator Romeo Labastida.

LPA toured the facility, conducted interviews, and reviewed facility files. The allegation indicates that the facility does not have the appropriate number of bathrooms for residents in care. LPA reviewed the facility sketch and observed that there are two (2) bathrooms for residents. There are currently six (6) residents in care and two (2) live-in staff. Interviews with staff and residents confirmed that there is one main bathroom and a secondary bathroom for the residents to use. Per regulation section 87307 Personal Accommodations and Services, there shall be 'at least one toilet and washbasin for each six (6) persons and at least one bathtub or shower for each ten (10) persons, which includes residents, family and live-in personnel.'

This agency has investigated the complaint allegation. We have found that the complaint was unfounded
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Christine LeTELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
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 5
Control Number 18-AS-20210715145003
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 DREAMLAND CARE VILLA
FACILITY NUMBER: 331880571
VISIT DATE: 07/16/2021
NARRATIVE
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meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to the administrator.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Christine LeTELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
07/15/2021 and conducted by Evaluator Christine Le
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210715145003

FACILITY NAME:A DREAMLAND CARE VILLAFACILITY NUMBER:
331880571
ADMINISTRATOR:ROMEO LABASTIDAFACILITY TYPE:
740
ADDRESS:12029 DRESSAGE LNTELEPHONE:
(951) 751-5875
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:6CENSUS: 6DATE:
07/16/2021
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Romeo LabastidaTIME COMPLETED:
10:36 AM
ALLEGATION(S):
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Resident left facility without staff knowledge.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Le conducted an unannounced visit to the facility to investigate the above allegation. LPA met with administrator Romeo Labastida.

LPA toured the facility, conducted interviews, and reviewed facility files. The allegation indicates that a female resident left the facility without staff knowledge. LPA observed that the facility was equipped with exiting door alarms which were all functional. LPA conducted interviews with staff and residents. Interviews in general denied that a female or male resident has left the facility without the staff knowing. During the interviews, LPA could not determine details of the alleged incident such as the identify of the resident and/or time/date of the incident.

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, therefore the allegation is unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Christine LeTELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20210715145003
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 DREAMLAND CARE VILLA
FACILITY NUMBER: 331880571
VISIT DATE: 07/16/2021
NARRATIVE
1
2
3
4
5
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7
8
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No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to the administrator.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Christine LeTELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5