331880960-2-3-2023-18-AS-JDHS-CPGRNW-20230228121057

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880960
Report Date: 02/03/2023
Date Signed: 02/03/2023 02:35:15 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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/08/2022 and conducted by Evaluator Yolanda Delgado

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220308093458

FACILITY NAME:	SIERRA RIDGE HOME		FACILITY NUMBER:	331880960
ADMINISTRATOR:	MARCAIDA, NATALIE		FACILITY TYPE:	735
ADDRESS:	30167 SIERRA RIDGE WAY		TELEPHONE:	(951) 926-9977
CITY:	MENIFEE	STATE: CA	ZIP CODE:	92585
CAPACITY:	4	CENSUS: 4	DATE:	02/03/2023
		UNANNOUNCED	TIME BEGAN:	01:12 PM
MET WITH:	Maribel Barajas, Caregiver		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff member hit resident leaving marks.
Staff member broke resident's glasses.
Staff did not adequately supervise residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to deliver findings for a complaint investigation into the allegations listed above. LPA met with Caregiver Maribel Barajas and discussed the purpose of the visit. LPA spoke to Administrator Omar Talla via telephone. During the course of the investigation, the department interviewed two (2) staff and two (2) residents.
In Regard to the allegation of staff hit a resident that left marks; interviews with S1, S2 and R2 did not corroborate with R1 allegation. In the allegation of staff member broke R1’s glasses; interviews with S1, S2 and R2 did not corroborate that R1’s glasses were broken by staff. In the allegation of staff did not adequately supervise residents; interviews with S1, S2, and R2 did not corroborate that R1 and other residents were not adequately supervised. The investigation revealed R1’s behavioral episodes would result in trying to hit other residents and staff, break own personal property in fits of rage and would walk out of the facility when R1 became upset. Staff intervened and contact law enforcement for assistance during R1’s behavioral episode and during the time frame that R1 was living at the facility.
(CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220308093458

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: SIERRA RIDGE HOME	FACILITY NUMBER: 331880960
	VISIT DATE: 02/03/2023

NARRATIVE

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(CONTINUED FROM 9099)

The information obtained for the allegations was not supported or corroborated by the evidence of S1, S2, R2, interviews, file review documents, documents received from Sierra Ridge Home.

Information obtained (S1, S2, R2’s interviews) and Investigations staff disclosed that no staff member hit a resident while in care, no staff member broke resident’s glasses while in care and that staff did not adequately supervise residents while in care. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was provided to Maribel Baragas along with LIC811 – Confidential Names List.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC9099 (FAS) - (06/04)

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