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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880803
Report Date: 01/27/2023
Date Signed: 01/27/2023 01:17:11 PM

Unsubstantiated


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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/09/2022 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 56-AS-20221209161254
FACILITY NAME:ENJOYCARE-POPLARFACILITY NUMBER:
331880803
ADMINISTRATOR:SUSAN FRIESFACILITY TYPE:
740
ADDRESS:11574 POPLAR STREETTELEPHONE:
(909) 796-1375
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:6CENSUS: 5DATE:
01/27/2023
UNANNOUNCEDTIME BEGAN:
12:49 PM
MET WITH:Susn Fries AdministratorTIME COMPLETED:
01:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident engaged in inappropriate behavior with another resident in care.
Staff are not providing adequate food service.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to deliver the findings for the allegation(s) above. LPA Allen met with Susan Fries who was informed of the purpose of the visit.

During LPA Allen investigation interviews were conducted with five (5) residents and three (3) staff members. Interviews were conducted with (R1),(R2),(R3),(R4) and (R5) and based on the interviews the residents said that no one has been inappropriate with them. The residents were also asked about adequate food service and they said that the food was to their satissfaction. The three (3) staff members were interviewed (S1),(S2) and (S3) and they inform LPA of the types of food provided along a menu.
LPA observed that there was a 7day supply of non-perishables and 5days suppy perishables.

Based on interviews and observations the during the investigation the above allegations are unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
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 56-AS-20221209161254
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
, CA 92507
FACILITY NAME: ENJOYCARE-POPLAR
FACILITY NUMBER: 331880803
VISIT DATE: 01/27/2023
NARRATIVE
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 A finding of Unsubstantiated means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

LPA conducted an exit interview was conducted where this report with appeal rights was discussed with Susan Fries and a copy was provided at the conclusion of the visit.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2