331881068-3-27-2026-18-AS-JDHS-DT5SRJ-20260414140626

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881068
Report Date: 03/27/2026
Date Signed: 03/27/2026 02:00:56 PM

Substantiated

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
01/26/2026 and conducted by Evaluator Robert Campbell

COMPLAINT CONTROL NUMBER: 18-AS-20260126132644

FACILITY NAME:	REM CALIFORNIA LLC - BAXTER		FACILITY NUMBER:	331881068
ADMINISTRATOR:	SIBANDE, CAROLINE		FACILITY TYPE:	735
ADDRESS:	13508 BAXTER COURT		TELEPHONE:	(951) 247-4555
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	4	CENSUS: 4	DATE:	03/27/2026
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Caroline Sibande/Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not provide adequate supervision to client in care resulting in hospitalization

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Robert Campbell made an unannounced visit to the facility to deliver findings regarding the allegation listed above. LPA met with Caroline Sibande/Administrator and explained the purpose of the visit and the elements of the allegation. LPA conducted an investigation, which consisted of interviews, observation, and record review.
On January 26, 2026, Community Care Licensing (CCL) received a complaint that alleged staff did not provide adequate supervision to client in care resulting in hospitalization. It was reported that Resident #1 sustained multiple falls due to not being properly supervised. Information obtained from interview with Administrator stated that Resident #1 does require two staff members for approximately 16 hours a day, but due to staffing issues, the requirement is unable to be met. Administrator indicated that Resident #1 did sustain multiple falls and that staff were not present. Administrator stated they did advise Inland Regional Center that the facility would be able to provide the staffing requirement for Resident #1. Information obtained from interview with additional staff did confirm that the facility does not have enough staff to provide the staff requirement to Resident #1.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Robert Campbell
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026

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-20260126132644

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: REM CALIFORNIA LLC - BAXTER	FACILITY NUMBER: 331881068
	VISIT DATE: 03/27/2026

NARRATIVE

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Interview with Inland Regional Center Service Coordinator also stated that the facility is required to provide two staff members to supervise Resident #1 since September 2025.

On February 3, 2026, at approximately 1:40 PM, Licensing Program Analysts (LPAs), Robert Campbell and Yolanda Delgado conducted an inspection at the facility. During the inspection LPAs observed two staff members present at the facility. LPAs observed that Resident#1 was sitting on the living room couch with Staff#2. Staff #1 escorted LPAs around the facility for approximately 10 minutes. At the initiation of the inspection, only Resident #1 was present. During the inspection, three additional residents arrived at the facility and no additional staff were able to provide supervision due to staff not responding to their shift.

During the investigation, LPAs conducted a record review of payroll time in & time out documents and found there was not enough staffing for a 2:1 ratio requirement for Resident#1 on the following dates: 12/1-12/7/25, 12/8–12/14/25, 12/15-12/21/25, 12/22-12/28/25, 12/29-1/04/26, 1/05-1/11/26, 1/26-2/01/26; 2pm-10pm: 1/12-18/26, 1/19-1/25/26).

Based on the information obtained in regards to the allegation that staff did not provide adequate supervision to client in care resulting in hospitalization, is substantiated. A substantiated finding means that the preponderance of evidence standard has been met; therefore, the above allegation is substantiated. This is in violation of Title 22 regulations, which is a potential risk to residents in care. The facility will be cited.

An exit interview was conducted. A copy of the report, along with the LIC 9099-D and appeal rights were provided to Caroline Sibande/Administrator.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Robert Campbell
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20260126132644

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: REM CALIFORNIA LLC - BAXTER	FACILITY NUMBER: 331881068
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/27/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/24/2026 Section Cited CCR 85078(a)(1)	1 2 3 4 5 6 7	85078(a)(1) Responsibility for Providing Care and Supervision: The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee will train re-train all staff on the needs and services plan by POC date. LIcensee will communitcate with Inland Regional to have a new plan for staffing for Resident#1 and send plan to LPA by POC date. Licensee will have a plan in place when staff calls off by POC date.
	8 9 10 11 12 13 14	On 1/12/2026, resident#1 was not being supervisied according to their needs and service plan, which resulted in hospitaliztion.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Robert Campbell
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026

LIC9099 (FAS) - (06/04)

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