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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530048
Report Date: 07/22/2025
Date Signed: 07/22/2025 02:31:45 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
07/18/2025 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250718094419
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: 3DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Administrator - Alix Garcia TIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent resident from harming other residents while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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, (2) client interviews and record reviews.

For the allegation, Staff did not prevent residents from harming other residents while in care.

During staff interviews 2 out of the 2 staff informed LPA they had prevented C1 and C2 from harming each other. S1 stated that C1 and C2 were separated from their argument. In addition, S1 is in the process of relocating C1 to a different Day Program to avoid altercation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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-20250718094419
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: 07/22/2025
NARRATIVE
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During client interviews, 2 out of the 2 clients stated they feel safe and have not been abused by other client nor staff. Based on the evidence found during the investigation, the one (1) allegation listed above is 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: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2