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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530048
Report Date: 01/22/2025
Date Signed: 01/22/2025 05:06:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
01/17/2025 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250117113517
FACILITY NAME:EMMA'S CASE ARF INC.FACILITY NUMBER:
335530048
ADMINISTRATOR:CHAVEZ, ALIX GARCIAFACILITY TYPE:
735
ADDRESS:20043 CASE STTELEPHONE:
(909) 316-9555
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY:4CENSUS: 2DATE:
01/22/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator - Alix Garcia TIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Staff hits a client while in care.
Staff inappropriately pushes a client while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with Administrator Alix Garcia and explained the purpose of the visit. The investigation consisted of (2) staff interviews, (2) client interviews and record review.

For allegation, Staff hits a client while in care.

During clients’ interviews, 2 out of the 2 clients stated they have not been hit while in care. C1 admitted to LPA Rico that staff did not hit them. In addition, 2 out of the 2 staff stated they have not hit their clients while in care and have not witness other staff hit their clients.

During record reviews, C1 notes indicated C1 had hit staff.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
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 56-AS-20250117113517
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: EMMA'S CASE ARF INC.
FACILITY NUMBER: 335530048
VISIT DATE: 01/22/2025
NARRATIVE
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For the allegation, Staff inappropriately pushes a client while in care.

During clients’ interviews, 2 out of the 2 clients stated they have not been pushed inappropriately while in care by staff. In addition, 2 out of the 2 staff stated they have not pushed a client while in care.

Based on the evidence found during the investigation, the two (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.


An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Alix Garcia.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2