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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530063
Report Date: 12/17/2024
Date Signed: 12/17/2024 10:31:29 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
11/26/2024 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241126085953
FACILITY NAME:SIERRA PINES GUEST HOMEFACILITY NUMBER:
335530063
ADMINISTRATOR:HAMED, HANANFACILITY TYPE:
740
ADDRESS:5051 LA SIERRA AVETELEPHONE:
(786) 219-6008
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:25CENSUS: 24DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee/Administrator-Hanan HamedTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Licensee is financially abusing resident.
INVESTIGATION FINDINGS:
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First Complaint: Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to deliver findings on the allegations listed above. LPA Singh met with Facility Licensee/Admicistrator Hanan Hamed and explained the purpose of the visit. The investigation consisted of interviews and review of records.

First allegation: Licensee is financially abusing resident.

The investigation was conducted by LPA Beena Singh. The investigation consisted of file review and interviews with relevant parties. The allegation indicates that staff is financially abusing client in care. During the investigation, LPA Beena Singh did not find evidence to support the allegation. Interviews on11/27/2024 with Four (4) of five (5) clients indicated that there's no staff at the facility that's financially abusing them.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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-20241126085953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SIERRA PINES GUEST HOME
FACILITY NUMBER: 335530063
VISIT DATE: 12/17/2024
NARRATIVE
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Four (4)) of five (5) clients interviewed by LPA Singh, revealed there's no incident that happened at the facility that a staff or Staff #1 (S1) is financially abusing them, and they did not hear or witness a staff financially abusing Client #1 (C1).

Moreover, interview with Licensee/ Administrator Staff#1, Client#1 has not been living in the facility since past three months and C#1 was admitted to Kaiser hospital on September 9th,2024 hospital and Innovage moved C#1 to nursing home in Los Angeles County as C#1 needed higher level of care.

Per documents review, LPA Beena Singh observed in documentation that C1 was receiving Social Security benefits checks and as C#1 has no forwarding address, Staff#1 contacted Social Security Administration (SSA) to stop sending the facility until she can give SSA forwarding address and no money was used from C#1 SSA checks that has been received to the facility and SSA fund has been refunded to the SSA on 11/27/2024 and 12/06/2024.

Based on the evidence found during the investigation, LPA Beena Singh found the allegations listed above to be Unsubstantiated.

Unsubstantiated; meaning 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.
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 was discussed and provided to Facility Administrator Hanan Hamed.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2