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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 11:21:58 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
12/04/2024 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241204113058
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:
10:35 AM
MET WITH:Facility Administrator Hanan HamedTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff harassed resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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 Administrator Hanan Hamed and explained the purpose of the visit. The investigation consisted of interviews and review of records.

First Allegation, Staff harassed resident in care.

LPA Singh interviewed Five (5) clients and according to five (5) out of five (5) clients, no one is persuading residents to switch providers and residents has not signed any insurance papers or documents at this facility. Facility has two insurance agencies coming to the facility due to residents have insurance with them but no other insurance agency visits the facility.

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-20241204113058
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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C#1 stated C#1 still have same insurance company. Clients at the facility deny having any issues with staff harassing residents regarding switching insurance providers.

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

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 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