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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336403613
Report Date: 11/10/2021
Date Signed: 11/10/2021 11:55:27 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/06/2020 and conducted by Evaluator Jennifer Semin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200306113325
FACILITY NAME:JIREH HOUSEFACILITY NUMBER:
336403613
ADMINISTRATOR:CASSANDRA KNIGHTENFACILITY TYPE:
735
ADDRESS:51935 RIZATELEPHONE:
(951) 849-1985
CITY:CABAZONSTATE: CAZIP CODE:
92230
CAPACITY:5CENSUS: 4DATE:
11/10/2021
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Cherron JacksonTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Facility staff caused injury to client in care
Client sustained unexplained bruising while in care
Lack of supervision resulting in client hitting another resident with an object
Facility is not safeguarding resident's personal belongings
Facility staff yells at client in care
Facility staff spoke inappropriately to client in care


INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jennifer Semin conducted an unannounced visit to initiate an investigation into the above complaint allegations. LPA met with House Manager Cherron Jackson.

The investigation consisted of interviews and record review. The first allegation, Facility staff caused injury to client in care. All staff stated, staff do not cause injuries to clients. All clients stated staff do not cause any injury to the clients. Client 1 (C1) stated he never had scratches on his neck or bruises on his legs. Staff 1 (S1) stated they have observed red marks on C1’s wrist that C1 state is from lifting objects at his worksite. C1 stated he has has red marks on his wrist from work. Client 2 (C2) stated he did not scratch C1. Relevant Party (RP) stated C1 told RP that Client 2 (C2) scratched him on his neck. No further information was received to cooroborate or refute the allegation.

The second allegation, Client sustained unexplained bruising while in care. All staff stated C1 has not had any unexplained bruising. S1 stated C1 has had bruising on his shin when returning from work. S1 stated
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
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 18-AS-20200306113325
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: JIREH HOUSE
FACILITY NUMBER: 336403613
VISIT DATE: 11/10/2021
NARRATIVE
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C1 reported bruising when returning from work that it is caused by the work he performs at his worksite. S1 stated that staff document body checks for clients in a daily body check log. LPA observed documents indicating body checks had been done. C1 stated he has never had any bruising on his body.

The third allegation, Lack of supervision resulting in client hitting another client with an object. All staff stated there is always 2 staff present when clients are present. S1 stated C1 and C2 are ambulatory and have general supervision. S1 stated staff provide assistance as needed and do intervene when behaviors arise. S1 stated C2 did not hit C1 with an object. Relevant Party (RP) stated C1 told RP that Client 2 (C2) hit him (C1) with an object. C1 stated C2 did not hit him with an object. No further information was received to cooroborate or refute the allegation.

The fourth allegation, Facility is not safeguarding client's personal belongings. All staff stated they safeguard all the client’s monies and belongings. S1 stated staff do not take any of the clients belongings. All clients stated staff do not take their belongings. LPA observed accurate documentation of all client monies and personal property inventories. No further information was received to cooroborate or refute the allegation.

The fifth allegation, Facility staff yells at client in care. All staff stated they do not yell at clients in care, nor have they heard any staff yell at any clients in care. All clients stated staff do not yell at any of the clients in care. No further information was received to cooroborate or refute the allegation.

The sixth allegation, Facility staff spoke inappropriately to clients in care. All staff stated they do not speak inappropriately to the clients in care, nor have they heard any staff speak inappropriately to any clients in care. All clients stated staff do not speak inappropriately to them. No further information was received to cooroborate or refute the allegation.

Based upon interviews and information gathered, and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.

An exit interview was conducted where this report was discussed and provided to Ms. Jackson.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2