335530048-5-23-2025-56-AS-EMAN-DJGSU5-20250711141034

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 335530048
Report Date: 05/23/2025
Date Signed: 05/23/2025 11:51:54 AM

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
05/19/2025 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20250519095534

FACILITY NAME:	EMMA'S CASE ARF INC.		FACILITY NUMBER:	335530048
ADMINISTRATOR:	CHAVEZ, ALIX GARCIA		FACILITY TYPE:	735
ADDRESS:	20043 CASE ST		TELEPHONE:	(909) 316-9555
CITY:	CORONA	STATE: CA	ZIP CODE:	92881
CAPACITY:	4	CENSUS: 2	DATE:	05/23/2025
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Administrator - Aix Garcia		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff administered a client's prescribed medication to another client 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 allegation listed above. LPA met with Administrator Alix Garcia and explained the purpose of the visit. The investigation consisted of (2) staff interviews, (1) client interviews and record review.

For the allegation Staff administrator, a client's prescribed medication to another client in care.

During staff interviews, 2 out of the 2 staff stated they have not administered a client's medication to another client in care. In addition, 2 out of the 2 staff informed LPA that each client has their own medication box, binder and MAR sheets. During client interviews, 1 out of the 1 client stated they recicved all their medication.

During medication audit, LPA verify all clients’ medications were dispense and documented properly.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025

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 56-AS-20250519095534

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: 05/23/2025

NARRATIVE

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Based on the evidence found during the investigation, the one (1) allegation 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: 05/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025

LIC9099 (FAS) - (06/04)

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