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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336408402
Report Date: 10/08/2025
Date Signed: 10/08/2025 02:41:30 PM

Substantiated


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
10/01/2025 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20251001104802

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:
10/08/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:House Manager Raven JohnsonTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not ensure faciltiy was free from pests
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Sarina Ramirez and Edith Conchas conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPAs met with House Manager Raven Johnson and explained the purpose of the visit.

Regarding allegation Staff did not ensure faciltiy was free from pests, House Manager confirmed the facility had bed bugs in two (2) bedrooms, the facility has been fumigated on 9/27/25, new mattresses, bed frames, and bed covers were delivered on 9/26/25 and 10/8/25.

Based on observation, record review, and interviews deficiencies were cited per Title 22, Division 6 of The California Code of Regulations.

An exit interview was conducted where the Licensing reports were discussed and copies of the reports with Appeal Rights was provided to House Manager Raven Johnson.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20251001104802
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: JUDAH HOUSE
FACILITY NUMBER: 336408402
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2025
Section Cited
CCR
80087(a)
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80087(a) Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
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Administrator has agreed to provide trainings for staff on how to detect bed bugs and the procedures needed to follow. Administrator will provided a training log with signatures to LPA and invoice of fumigation by POC due date
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Based on observation, record review, and interview, the licensee did not comply with the section cited above by not keeping the facility free of bed bugs. which poses an immediate health, safety and personal rights risks to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3