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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334840745
Report Date: 06/05/2024
Date Signed: 06/05/2024 12:56:12 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/04/2024 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20240604132014
FACILITY NAME:FSA-OLIVEWOOD CDCFACILITY NUMBER:
334840745
ADMINISTRATOR:FLOR MARTINEZFACILITY TYPE:
850
ADDRESS:23268 OLIVEWOOD PLAZA DR.TELEPHONE:
(951) 924-6100
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:144CENSUS: 41DATE:
06/05/2024
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Flor Martinez, DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not ensure that the day care toilets were fixed timely
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to investigate the above stated allegation. LPA met with and advised Director Flor Martinez (S1) of an open investigation. LPA conducted a tour and census of the facility. LPA conducted interviews with S1 and two other staff and made observations, and received documentation to assist with providing a finding in this investigation.

It was alleged that toilets were overflowing when being flushed causing the children to have to use the bathroom in toilets that were already full. In the statement provided in the allegation, it was later clarified that the toilets were able to be flushed, but at a slower rate than others. Staff who were interviewed relayed that while service was being conducted to repair a clogged drain, children were able to utilize other working and flushing toilets.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
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 10-CC-20240604132014
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: FSA-OLIVEWOOD CDC
FACILITY NUMBER: 334840745
VISIT DATE: 06/05/2024
NARRATIVE
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Upon finding that the drains were clogged facility-wide, S1 relayed and provided documentation revealing that the issue was discovered on 6/3/24 at approximately 9:11am when S1 reported the incident to their management. On the same date, record review revealed that on 6/3/24, at approximately 9:12am, the facility maintenance department received and acknowledged the issue and S1 relayed that a plumber responded on that day. When the issue continued, on 6/4/24, record review indicated that at approximately 10:04am, Trinity Plumbing would be addressing the issue within an hour.

LPA tested all of the toilets on today's date, and found that all of them are in working condition.

Due to staff interview, record review, and LPA observation, the allegation was Unsubstantiated.

A finding of UNSUBSTANTIATED means that 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.

An exit interview was conducted, where a copy of this report, LIC9099C, and LIC811 was discussed and provided to S1 along with a copy of the Appeal Rights. A notice of site visit was also posted and must remain posted for 30 days.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC9099 (FAS) - (06/04)
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