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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336408402
Report Date: 05/10/2024
Date Signed: 05/10/2024 09:47:54 AM

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
04/11/2024 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240411161017
FACILITY NAME:JUDAH HOUSEFACILITY NUMBER:
336408402
ADMINISTRATOR:CASSANDRA KNIGHTENFACILITY TYPE:
735
ADDRESS:13400 CHAPARRAL ROADTELEPHONE:
(951) 378-3800
CITY:CABAZONSTATE: CAZIP CODE:
92230
CAPACITY:5CENSUS: 4DATE:
05/10/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Raven Johnson - ManagerTIME COMPLETED:
09:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to deliver findings on the above complaint allegation. LPA met with Raven Johnson, Manager, and discussed the purpose of the visit.

Regarding the allegation, staff hit resident, four (4) staff interviewed deny hitting a resident and have not witnessed other staff hit a resident. Three (3) residents interviewed deny staff hit them and have not witnessed staff hit other residents.

Based on LPA observations and interviews with pertinent parties, the above allegation is 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.

An exit interview was conducted where this report was discussed and a copy with appeal rights was provided to Manager Johnson at the conclusion of the visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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