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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880711
Report Date: 10/11/2025
Date Signed: 10/11/2025 11:45:54 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
06/30/2022 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220630141557
FACILITY NAME:AVALON RANCH RESIDENTIAL FACILITYFACILITY NUMBER:
331880711
ADMINISTRATOR:WALKER, DANAFACILITY TYPE:
735
ADDRESS:1521 AVILA DRIVETELEPHONE:
(951) 796-7623
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:4CENSUS: 4DATE:
10/11/2025
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:DSP Emely CampasTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility staff is isolating resident due to behavior issue
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with DSP worker Emely Campas and explained the purpose of the visit. Facility Administrator Adie Walker was notified by telephone.

The investigation consisted of the following: During the initial visit conducted on 07/08/2022, LPA Venus Mixson and LPM Jazmond Harris conducted interviews with Administrator, staff S1-S3, and requested pertinent documentation. LPA and LPM conducted a safety inspection of the facility; no deficiencies were observed. On today’s visit LPA Gutierrez interviewed staff #4 (S4), staff #5 (S5) by telephone, clients #1 -clients #2 (C2-C2), and attempted phone interview with client #3 (C3) no answer. LPA obtained copies of the following documents: staff roster, client roster, C1’s face sheet, physicians report LIC 602, and individual program plan IPP. During today’s visit LPA Gutierrez delivered findings.

SEE 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2025
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 18-AS-20220630141557
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: AVALON RANCH RESIDENTIAL FACILITY
FACILITY NUMBER: 331880711
VISIT DATE: 10/11/2025
NARRATIVE
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In regard to the allegation “Facility staff is isolating resident due to behavior issue”, it is alleged that due to behavior issues C1 was isolated to his/her room by staff only being allowed to come out for meals. During interviews with Administrator and staff five (5) out of five (5) staff stated that clients’ rights are not violated and they are not isolated to their rooms. S4 stated that sometimes clients are sent to their rooms to cool down not as a punishment and are right back out within less than an hour. During interviews with clients two (2) out of two (2) clients stated that staff have never isolated them to their rooms as a form of punishment. When asked if they have ever been sent to room by staff C1 stated “No”. C2 stated that if he/she is having a bad day then they will just go to their room themselves. D

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was given.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2