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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336405670
Report Date: 10/15/2021
Date Signed: 10/15/2021 10:46:24 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
03/05/2020 and conducted by Evaluator Jennifer Semin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200305115056
FACILITY NAME:SLB INCORPORATED-MESA TOPFACILITY NUMBER:
336405670
ADMINISTRATOR:LIBERTY HALLFACILITY TYPE:
735
ADDRESS:28331 MESA TOP TRAILTELEPHONE:
(951) 485-6779
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:6CENSUS: 6DATE:
10/15/2021
UNANNOUNCEDTIME BEGAN:
08:34 AM
MET WITH:Michael HallTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
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5
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9
Clients are left soiled over night
Client needs are not been met
Clients are not been properly supervised
Client is denied telephone to make calls
INVESTIGATION FINDINGS:
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2
3
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5
6
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13
Licensing Program Analyst (LPA) Jennifer Semin conducted an unannounced visit to deliver the findings for the above complaint allegations. LPA met with Direct Care Staff, Lilibeth Galang. Licensee, Michael Hall was notified via telephone and arrived during the visit.

The investigation consisted of interviews with staff and clients and review of pertinent documents.
The first allegation, Clients are left soiled overnight. Staff interviewed deny leaving clients soiled overnight and presented documentation to support that staff check clients every 2-3 hours. Client 1 (C1) states staff do not come in a change soiled diaper overnight. Client 2-5 were unable to refute or corroborate the allegation due to cognitive impairment.
The second allegation, Client needs are not been met. Staff interviews revealed staff tend to the clients and meet all their needs. Staff stated they interact with all their clients throughout the day through meaningful activities. C1 stated staff only tend to C1 when C1 calls out for them. LPA observed staff interacting with all clients through active treatment and game play.
The third allegation, Clients are not been properly supervised. Staff interviews and staff schedules indicate
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
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-20200305115056
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: SLB INCORPORATED-MESA TOP
FACILITY NUMBER: 336405670
VISIT DATE: 10/15/2021
NARRATIVE
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that there is sufficient staff present during all hours. C1 stated there is always staff present.
The fourth allegation, Client is denied telephone to make calls. Staff interviewed stated no client is ever denied telephone use. Staff 1 and Staff 2 state C1 believes calls made to the facility are for C1 even when staff tell C1 it was not a call directed to C1. Staff stated all clients including C1 receive any and all calls for them and can make calls when desired. C1 stated C1 speaks to their family via telephone weekly.

Based on interviews and documents reviewed 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 Mr. Hall
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2