331881500-9-3-2025-18-AS-JDHS-DM3TS5-20251002145834

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881500
Report Date: 09/03/2025
Date Signed: 09/03/2025 01:05:49 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
05/13/2025 and conducted by Evaluator Venus Mixson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20250513115017

FACILITY NAME:	LA PALMA WAY HOME LLC		FACILITY NUMBER:	331881500
ADMINISTRATOR:	EMBALSADO, MAY BOCO		FACILITY TYPE:	735
ADDRESS:	15306 LA PALMA WAY		TELEPHONE:	(951) 247-7015
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	6	CENSUS: 5	DATE:	09/03/2025
		UNANNOUNCED	TIME BEGAN:	12:44 PM
MET WITH:	ADMINISTRATOR, MAY BOCO EMBALSADO		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Staff isolate client in care

INVESTIGATION FINDINGS:

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On September 03, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced and met with May Boco Embalsado, Administrator. LPA explained the reason for the visit was to provide findings for the complaint investigation. During the investigation, LPA conducted interviews, record reviews, and made observations. LPA was not able to interview additional witness who were pertinent to the complaint investigation due to LPA’s inability to obtain contact with additional witnesses.

On May 13, 2025, Community Care Licensing received a complaint alleging staff isolate client in care. It was reported Resident #1 (R1) resides in an Adult Residential Facility and is being isolated. It was reported R1 is being excluded from family, is required to be in their room for a majority of the day; not allowed to attend their day program or outings and is not allowed to have a television or radio. Information obtained from interview with

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2025

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 3

Control Number 18-AS-20250513115017

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: LA PALMA WAY HOME LLC	FACILITY NUMBER: 331881500
	VISIT DATE: 09/03/2025

NARRATIVE

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Information obtained from interview with Administrator stated that the allegations were false. It was stated that R1 does attend daily, weekly, and seasonal outings of their choice. It was further advised that R1 goes on daily walks with their family and friends, monthly shopping trips, and has weekly overnight visits with family and friends.

Administrator stated that R1 has attended the same day program for approximately 20 years. Information obtained from additional staff corroborated the information provided by Administration. Information obtained from interview with R1 denied the allegations that they are isolated. R1 stated they do not attend the day program as much since they have graduated and a lot of their friends and staff, they were close to no longer attending.

R1 advised they do have television and radio and are allowed to access them when they desire. R1 stated there are no issues or concerns regarding the facility. Interviews with additional residents indicated there are no concerns with isolation and not having adequate activities. Information obtained from additional witness revealed R1 is home with family and friends for every holiday and every other weekend, no concerns. A review of the records confirmed facility does schedule activities in which most residents participate in. Additional record reviews confirmed R1 attends scheduled medical, dental, and other appointments. LPA’s observations of R1’s morning routine and respective living quarters, verified R1 has television and radio, that R1 is allowed to access.

Based on interviews, record reviews, observations, and the inability to interview relevant parties, the allegation staff isolate client in care, has been deemed unsubstantiated. Information obtained was not sufficient to support the listed allegation. Although the allegation may have happened, there is not a preponderance of evidence to determine if the alleged violation did nor did not occur.

An exit interview was conducted. A copy of this report was discussed and provided to Administrator, May Boco Embalsado.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20250513115017

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: LA PALMA WAY HOME LLC	FACILITY NUMBER: 331881500
	VISIT DATE: 09/03/2025

NARRATIVE

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Further information obtained from interviews with additional staff indicated R1 enjoys spending time with family and friends, nature walks, shopping at the mall, and getting ice cream weekly with family. It was explained R1 has successfully completed many of the skills training and programs at the day program after attending for over 20 years. LPA was unable to contact, and interview witness due to witness not answering or returning LPA’s numerous phone calls. When interviewed R1 indicated they do have television and radio, and they have graduated from the day program. R1 shared their friends are no longer there at the day program. Additionally, the day program staff, which R1 had social ties with, are no longer working there. Information obtained from interviews with residents indicated there were no concerns regarding staff isolating R1 or any of the residents in the facility. There are scheduled activities provided for the residents in care, and they may participate in the activities of their choice. A review of the records confirmed facility does scheduled activities. The facility provided posted activities schedule and an additional activity schedule of R1’s scheduled appointments and other community events. Information obtained from additional witness revealed R1 is home with family and friends for every holiday and every other weekend.

LPA’s review of the records demonstrated there was documentation of scheduled activities with R1 and family and friends. Additional record reviews confirmed R1 attends scheduled medical, dental and other appointments. LPA’s observations of R1’s morning routine and respective living quarters verified TV, radio and other personal items of choice.

Based on interviews, record reviews, observations, and the inability to interview relevant parties, the allegation “Staff isolate client in care” has been deemed unsubstantiated. Information obtained was not sufficient to support the listed allegation. Although the allegation may have happened, there is not a preponderance of evidence to determine if the alleged violation did nor did not occur.
An exit interview was conducted. A copy of this report was discussed and provided to Administrator, May Boco Embalsado.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025

LIC9099 (FAS) - (06/04)

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