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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336410622
Report Date: 05/30/2023
Date Signed: 05/30/2023 03:08:36 PM

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
05/26/2023 and conducted by Evaluator Ryan Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230526112714
FACILITY NAME:NOAH'S ADULT HOMEFACILITY NUMBER:
336410622
ADMINISTRATOR:OLGA MORALESFACILITY TYPE:
735
ADDRESS:806 HOMESTEAD ROADTELEPHONE:
(951) 549-1314
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY:5CENSUS: 4DATE:
05/30/2023
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Olga Morales- AdministratorTIME COMPLETED:
03:17 PM
ALLEGATION(S):
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Staff does not allow resident to leave facility.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Ryan Gardner and Mary Rico made an unannounced visit to the facility to investigate and issue findings for the allegation listed above. LPAs stated the purpose of the visit and was granted entry and met with Administrator Olga Morales. The visit today consisted of interviews and document review.

For allegation, Staff does not allow resident to leave facility:

It was alleged that Client C1 wanted to leave the facility on 5/26/22 on their own to visit some friends and facility staff did not allow C1 to leave.

During document review, LPAs reviewed C1’s physician’s report dated 3/9/2023. C1’s physician’s report states that C1 is not able to leave the facility unassisted.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
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-20230526112714
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: NOAH'S ADULT HOME
FACILITY NUMBER: 336410622
VISIT DATE: 05/30/2023
NARRATIVE
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During interviews with clients, C1 stated that they are not allowed to leave the facility unless they are accompanied by staff. C2 stated that the facility staff allows the clients to leave the facility. C2 stated the staff does not prevent the clients from spending time with their friends and family outside of the facility. LPAs attempted to interview C3 and C4, both clients did not respond verbally.

During interviews staff, the staff stated that C1 is allowed to leave the facility with the assistance of the staff. The facility assists C1 to leave the facility per C1’s physician’s report.

Based on evidence obtained, the allegation listed above is deemed UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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.

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 (LIC9099) was discussed and provided to Administrator Olga Morales, along with a copy of the appeal rights.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2