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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880819
Report Date: 04/18/2025
Date Signed: 04/18/2025 12:54:18 PM

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
12/03/2021 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 18-AS-20211203161535
FACILITY NAME:CALEB HOMEFACILITY NUMBER:
331880819
ADMINISTRATOR:SAMANTHA PADILLAFACILITY TYPE:
735
ADDRESS:49252 PLUMA VERDE PLACETELEPHONE:
(760) 601-7307
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY:4CENSUS: 4DATE:
04/18/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Stephanie Olivas, AdministratorTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Staff do not treat resident with dignity and respect
Administrator failed to address resident's concern
INVESTIGATION FINDINGS:
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On 4/18/2025 at 10:20 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegation. LPA Serrano explained the purpose of the visit to the administrator Stephanie Olivas. The investigation consisted of file review, interview with the administrator as well as observation.

Allegation #1 - Staff do not treat resident with dignity and respect – Based on special incident report (SIR) submitted by the facility, it indicated that the resident #1 (R1) was always under constant supervision for behavioral issue. R1 is treated with dignity and respect. Information received did not corroborate with the allegation. During today’s visit, LPA observed that R1 is no longer residing at the facility. Additional interview with alleged victim and witness were unable to be conducted at this time due to unavailability.

*** Continuation in LIC9099C ***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
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-20211203161535
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: CALEB HOME
FACILITY NUMBER: 331880819
VISIT DATE: 04/18/2025
NARRATIVE
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Allegation #2 - Administrator failed to address resident's concern – Based on file review and interview with administrator, it showed that the facility has the house rules and grievance policy that the client signed that stated the process of how to address the client’s concerns and grievances. Facility also provided the staff monthly training that covered house rules and grievance policy. Information received during investigation did not corroborate with the allegation.

During the investigation, LPA did not find evidence to corroborate the allegations.

Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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 allegations are unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099, LIC9099C were discussed and provided to the administrator Stephanie Olivas.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2